Provider Demographics
NPI:1629496005
Name:KEECH, SPENCER (PC)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:KEECH
Suffix:
Gender:M
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-2814
Mailing Address - Country:US
Mailing Address - Phone:216-939-3709
Mailing Address - Fax:216-631-3654
Practice Address - Street 1:7800 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-2814
Practice Address - Country:US
Practice Address - Phone:216-939-3709
Practice Address - Fax:216-631-3654
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1200011101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health