Provider Demographics
NPI:1407440597
Name:KEEFFE, GLEN DOUGLAS (LMHC, MA)
Entity Type:Individual
Prefix:
First Name:GLEN
Middle Name:DOUGLAS
Last Name:KEEFFE
Suffix:
Gender:M
Credentials:LMHC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 N PERRY AVE
Mailing Address - Street 2:
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-9242
Mailing Address - Country:US
Mailing Address - Phone:509-670-2686
Mailing Address - Fax:
Practice Address - Street 1:25 N WENATCHEE AVE STE 214
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2283
Practice Address - Country:US
Practice Address - Phone:509-670-2686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-01
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMHC.LH.61116350101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health