Provider Demographics
NPI:1659505444
Name:KEEN, JULIE A (PSYD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:KEEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 GREEN GARDEN WAY
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-6757
Mailing Address - Country:US
Mailing Address - Phone:860-280-7605
Mailing Address - Fax:
Practice Address - Street 1:849 GREEN GARDEN WAY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-6757
Practice Address - Country:US
Practice Address - Phone:860-251-9508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003217103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1376067009Medicaid