Provider Demographics
NPI:1326793993
Name:KEENAN, MARLO (LPC)
Entity Type:Individual
Prefix:
First Name:MARLO
Middle Name:
Last Name:KEENAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 BARRETT LAKES BLVD NW APT 1226
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-7535
Mailing Address - Country:US
Mailing Address - Phone:770-712-5020
Mailing Address - Fax:
Practice Address - Street 1:1950 BARRETT LAKES BLVD NW APT 1226
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7535
Practice Address - Country:US
Practice Address - Phone:770-712-5020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-12
Last Update Date:2022-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009746101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty