Provider Demographics
NPI:1326286980
Name:KEITH, KAISHA (LPC , LCPC)
Entity Type:Individual
Prefix:
First Name:KAISHA
Middle Name:
Last Name:KEITH
Suffix:
Gender:F
Credentials:LPC , LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14100 MAGELLAN PLZ
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-4644
Mailing Address - Country:US
Mailing Address - Phone:800-462-1812
Mailing Address - Fax:
Practice Address - Street 1:14100 MAGELLAN PLZ
Practice Address - Street 2:14100 MAGELLAN PLAZA
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-4644
Practice Address - Country:US
Practice Address - Phone:800-462-1812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3024101YP2500X
VA0701004578101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional