Provider Demographics
NPI:1265682744
Name:KEENAN, KATIE LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:LYNN
Last Name:KEENAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:KATIE
Other - Middle Name:LYNN
Other - Last Name:GLENN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 191155
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83719-1155
Mailing Address - Country:US
Mailing Address - Phone:949-922-6200
Mailing Address - Fax:
Practice Address - Street 1:707 N ARMSTRONG PL
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-0825
Practice Address - Country:US
Practice Address - Phone:208-375-5211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-22
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-341831041C0700X
CA290901041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical