Provider Demographics
NPI:1457026569
Name:KEITH, ALLISON SUE (LPC)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:SUE
Last Name:KEITH
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 1:309 N BROADVIEW ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3816
Mailing Address - Country:US
Mailing Address - Phone:316-992-5347
Mailing Address - Fax:
Practice Address - Street 1:309 N BROADVIEW ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3816
Practice Address - Country:US
Practice Address - Phone:316-992-5347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional