Provider Demographics
NPI:1457080913
Name:ALLEY, KEEGAN (LMFT)
Entity Type:Individual
Prefix:
First Name:KEEGAN
Middle Name:
Last Name:ALLEY
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 MARINE CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-3513
Mailing Address - Country:US
Mailing Address - Phone:817-515-7132
Mailing Address - Fax:
Practice Address - Street 1:4801 MARINE CREEK PKWY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179-3513
Practice Address - Country:US
Practice Address - Phone:817-515-7132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health