Provider Demographics
NPI:1497101208
Name:HEBERT, KEITH
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:HEBERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 CRAWFORD ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-5031
Mailing Address - Country:US
Mailing Address - Phone:713-208-0123
Mailing Address - Fax:713-795-4660
Practice Address - Street 1:4720 CRAWFORD ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-5031
Practice Address - Country:US
Practice Address - Phone:713-208-0123
Practice Address - Fax:713-795-4660
Is Sole Proprietor?:No
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator