Provider Demographics
NPI:1558483255
Name:KECK, DARRYL L (MSW)
Entity Type:Individual
Prefix:MR
First Name:DARRYL
Middle Name:L
Last Name:KECK
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 PLACERVILLE DR STE 17
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-3972
Mailing Address - Country:US
Mailing Address - Phone:530-621-6303
Mailing Address - Fax:530-622-1293
Practice Address - Street 1:344 PLACERVILLE DR STE 17
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-3972
Practice Address - Country:US
Practice Address - Phone:530-621-6303
Practice Address - Fax:530-622-1293
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 94691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical