Provider Demographics
NPI:1790860245
Name:KEOWN, BRENDA (LPCC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:KEOWN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 CAVE RIDGE LN.
Mailing Address - Street 2:
Mailing Address - City:HORSE BRANCH
Mailing Address - State:KY
Mailing Address - Zip Code:42349
Mailing Address - Country:US
Mailing Address - Phone:270-274-9950
Mailing Address - Fax:
Practice Address - Street 1:608 HAPPY VALLEY RD
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-1561
Practice Address - Country:US
Practice Address - Phone:270-901-5000
Practice Address - Fax:270-842-5268
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30604011Medicaid