Provider Demographics
NPI:1568999050
Name:PHILLIP S KECK, PHD, LLC
Entity Type:Organization
Organization Name:PHILLIP S KECK, PHD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:KECK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:804-640-6848
Mailing Address - Street 1:PO BOX 13650
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-8650
Mailing Address - Country:US
Mailing Address - Phone:804-640-6848
Mailing Address - Fax:
Practice Address - Street 1:681 HIOAKS RD STE E
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-4043
Practice Address - Country:US
Practice Address - Phone:804-420-9189
Practice Address - Fax:844-308-5846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005353103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty