Provider Demographics
NPI:1417495979
Name:MISTI KEEN, LPC, PC
Entity Type:Organization
Organization Name:MISTI KEEN, LPC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MISTI
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:KEEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:334-437-5742
Mailing Address - Street 1:590 S BOUTWELL RD
Mailing Address - Street 2:
Mailing Address - City:FOREST HOME
Mailing Address - State:AL
Mailing Address - Zip Code:36030-5327
Mailing Address - Country:US
Mailing Address - Phone:334-437-5742
Mailing Address - Fax:
Practice Address - Street 1:590 S BOUTWELL RD
Practice Address - Street 2:
Practice Address - City:FOREST HOME
Practice Address - State:AL
Practice Address - Zip Code:36030-5327
Practice Address - Country:US
Practice Address - Phone:334-437-5742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-05
Last Update Date:2017-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3395251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health