Provider Demographics
NPI:1518962810
Name:KECK, ALAN D (PSYD)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:D
Last Name:KECK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 WEST PINEVIEW STREET
Mailing Address - Street 2:SUITE 1005
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2060
Mailing Address - Country:US
Mailing Address - Phone:407-644-2000
Mailing Address - Fax:407-644-3484
Practice Address - Street 1:125 WEST PINEVIEW STREET
Practice Address - Street 2:SUITE 1005
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2060
Practice Address - Country:US
Practice Address - Phone:407-644-2000
Practice Address - Fax:407-644-3484
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73604Medicare ID - Type UnspecifiedMEDICARE IDENTIFIER