Provider Demographics
NPI:1659783058
Name:KEITH IDELL, LCSW, P.C.
Entity Type:Organization
Organization Name:KEITH IDELL, LCSW, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:IDELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:828-200-3739
Mailing Address - Street 1:1 BRADDOCK WAY
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2035
Mailing Address - Country:US
Mailing Address - Phone:828-200-3739
Mailing Address - Fax:828-575-2698
Practice Address - Street 1:5 ALLEN AVE STE B
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2272
Practice Address - Country:US
Practice Address - Phone:828-200-3739
Practice Address - Fax:828-575-2698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-20
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC201412200314251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health