Provider Demographics
NPI:1346377611
Name:KEITH, JENNIFER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:KEITH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:KEITH
Other - Last Name:BOONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:1281 OLDFIELD RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-4581
Mailing Address - Country:US
Mailing Address - Phone:404-274-0387
Mailing Address - Fax:
Practice Address - Street 1:315 W PONCE DE LEON AVE
Practice Address - Street 2:SUITE 440
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2400
Practice Address - Country:US
Practice Address - Phone:404-585-4940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002996103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling