Provider Demographics
NPI:1497189146
Name:RIGBY, KEITH BRYANT (MSW)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:BRYANT
Last Name:RIGBY
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:KEITH
Other - Middle Name:BRYANT
Other - Last Name:RIGBY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:150 CREEKSIDE LN
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-8679
Mailing Address - Country:US
Mailing Address - Phone:541-941-4209
Mailing Address - Fax:707-238-6461
Practice Address - Street 1:150 CREEKSIDE LN
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-8679
Practice Address - Country:US
Practice Address - Phone:541-941-4209
Practice Address - Fax:707-238-6461
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96933101YM0800X
171M00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator