Provider Demographics
NPI:1790745453
Name:MOREHOUSE, KEITH D (LCSW)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:D
Last Name:MOREHOUSE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 WALLACE BLVD
Mailing Address - Street 2:BUILDING 501
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1705
Mailing Address - Country:US
Mailing Address - Phone:806-351-3200
Mailing Address - Fax:806-351-3344
Practice Address - Street 1:901 WALLACE BLVD
Practice Address - Street 2:BUILDING 501
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1705
Practice Address - Country:US
Practice Address - Phone:806-351-3200
Practice Address - Fax:806-351-3344
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX299881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87495QOtherBLUE CROSS NUMBER WITH GR
TX8G2759Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER