Provider Demographics
NPI:1598538084
Name:KEENAN, MICHAEL BOHMONT (MS MFT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BOHMONT
Last Name:KEENAN
Suffix:
Gender:M
Credentials:MS MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 E RAY RD STE 131
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-4206
Mailing Address - Country:US
Mailing Address - Phone:480-256-2999
Mailing Address - Fax:
Practice Address - Street 1:633 E RAY RD STE 131
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-4206
Practice Address - Country:US
Practice Address - Phone:480-256-2999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAMFT-08017T106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist