Provider Demographics
NPI:1538665062
Name:KEENAN, JOEY (CADC - 1)
Entity Type:Individual
Prefix:
First Name:JOEY
Middle Name:
Last Name:KEENAN
Suffix:
Gender:M
Credentials:CADC - 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17440 COHASSET ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-2409
Mailing Address - Country:US
Mailing Address - Phone:818-802-9331
Mailing Address - Fax:
Practice Address - Street 1:4463 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-2911
Practice Address - Country:US
Practice Address - Phone:818-205-9069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA123815101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)