Provider Demographics
NPI:1811397110
Name:KEENBERG, CASEY (LPC)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:KEENBERG
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:
Other - Last Name:LEAVENWORTH-KEENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-0188
Mailing Address - Country:US
Mailing Address - Phone:520-616-1510
Mailing Address - Fax:520-616-1511
Practice Address - Street 1:2325 N WYATT DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2121
Practice Address - Country:US
Practice Address - Phone:520-616-1510
Practice Address - Fax:520-616-1511
Is Sole Proprietor?:No
Enumeration Date:2014-08-25
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
AZLPC-21407101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ160516Medicaid