Provider Demographics
NPI:1609331453
Name:KEENER, TERRI (LCSW, LSCSW)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:KEENER
Suffix:
Gender:F
Credentials:LCSW, LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 TEMPO ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-6461
Mailing Address - Country:US
Mailing Address - Phone:702-303-0049
Mailing Address - Fax:
Practice Address - Street 1:1319 TEMPO ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-6461
Practice Address - Country:US
Practice Address - Phone:702-303-0049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS16571041C0700X
NV4687-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical