Provider Demographics
NPI:1407490535
Name:BEDELL, KEISHA LANESE (LPC)
Entity Type:Individual
Prefix:
First Name:KEISHA
Middle Name:LANESE
Last Name:BEDELL
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 1:1686 UNDERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-4036
Mailing Address - Country:US
Mailing Address - Phone:216-269-0367
Mailing Address - Fax:
Practice Address - Street 1:1221 E WATERLOO RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-3805
Practice Address - Country:US
Practice Address - Phone:234-208-4181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1902202101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor