Provider Demographics
NPI:1275268054
Name:MEDLEY, KEITH ALAN (LPC)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:ALAN
Last Name:MEDLEY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 N CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15683-1007
Mailing Address - Country:US
Mailing Address - Phone:724-323-2776
Mailing Address - Fax:
Practice Address - Street 1:817 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SCOTTDALE
Practice Address - State:PA
Practice Address - Zip Code:15683-1007
Practice Address - Country:US
Practice Address - Phone:724-323-2776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC014642101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health