Provider Demographics
NPI:1619356987
Name:EMMONS, KEITH ROGER (BS)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:ROGER
Last Name:EMMONS
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 CIRCLE OF PROGRESS DR
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-3811
Mailing Address - Country:US
Mailing Address - Phone:610-970-5410
Mailing Address - Fax:
Practice Address - Street 1:301 CIRCLE OF PROGRESS DR
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3811
Practice Address - Country:US
Practice Address - Phone:610-970-5410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)