Provider Demographics
NPI:1518672732
Name:KECK, RAQUEL ALEXANDRA
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:ALEXANDRA
Last Name:KECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 LOKER AVE W # 11409
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92010-6603
Mailing Address - Country:US
Mailing Address - Phone:760-450-6767
Mailing Address - Fax:
Practice Address - Street 1:2040 SHASTA ST STE AANDC
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0470
Practice Address - Country:US
Practice Address - Phone:530-768-7397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist