Provider Demographics
NPI:1467991281
Name:KEYES, DEVIN (LPC)
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:
Last Name:KEYES
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 HARTFORD TPKE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4784
Mailing Address - Country:US
Mailing Address - Phone:860-474-0630
Mailing Address - Fax:
Practice Address - Street 1:281 HARTFORD TPKE
Practice Address - Street 2:SUITE 104
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4784
Practice Address - Country:US
Practice Address - Phone:860-474-0630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3102101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor