Provider Demographics
NPI:1760753867
Name:MARSHALL, KEITH LAMONT (PSYD, MHD,CATC V)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:LAMONT
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:PSYD, MHD,CATC V
Other - Prefix:DR
Other - First Name:DR KEITH
Other - Middle Name:LAMONT
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD, MHD, CATCV
Mailing Address - Street 1:133 N ALTADENA DR STE 401
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-7330
Mailing Address - Country:US
Mailing Address - Phone:626-644-8857
Mailing Address - Fax:
Practice Address - Street 1:133 N ALTADENA DR STE 401
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-7330
Practice Address - Country:US
Practice Address - Phone:626-921-0113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-20
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X, 103T00000X, 103TB0200X, 106H00000X
CA091947V101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty