Provider Demographics
NPI:1629521257
Name:KEITH, GREGORY (MA, LPCC, LICDC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:KEITH
Suffix:
Gender:M
Credentials:MA, LPCC, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3118 HANNA AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-6913
Mailing Address - Country:US
Mailing Address - Phone:330-441-1538
Mailing Address - Fax:
Practice Address - Street 1:5 E LIBERTY ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-8202
Practice Address - Country:US
Practice Address - Phone:513-381-2247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1300112101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional