Provider Demographics
NPI:1821214107
Name:KEEDY, JAMES B (LPC LMFT LSOTP)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:B
Last Name:KEEDY
Suffix:
Gender:M
Credentials:LPC LMFT LSOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8820 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-6318
Mailing Address - Country:US
Mailing Address - Phone:210-826-8686
Mailing Address - Fax:210-826-8624
Practice Address - Street 1:8820 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-6318
Practice Address - Country:US
Practice Address - Phone:210-826-8686
Practice Address - Fax:210-826-8624
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9498101Y00000X
TX6192101YA0400X
TX10216101YP2500X
TX3594106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143327801Medicaid