Provider Demographics
NPI:1497020291
Name:EKNESS, KEITH L (LMSW)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:L
Last Name:EKNESS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 N MEYER RD
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-5939
Mailing Address - Country:US
Mailing Address - Phone:208-661-0093
Mailing Address - Fax:
Practice Address - Street 1:2810 N MEYER RD
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-5939
Practice Address - Country:US
Practice Address - Phone:208-661-0093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-30275104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker