Provider Demographics
NPI:1558373506
Name:HOWARD, KEITH (PHD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:HOWARD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 S STATE COLLEGE BLVD APT 3063
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-0136
Mailing Address - Country:US
Mailing Address - Phone:949-231-9025
Mailing Address - Fax:
Practice Address - Street 1:800 N ECKHOFF ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-1008
Practice Address - Country:US
Practice Address - Phone:714-704-8818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20187103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical