Provider Demographics
NPI:1821421918
Name:KEAN, KATHLEEN MICHELE (LPC-S, NCC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MICHELE
Last Name:KEAN
Suffix:
Gender:F
Credentials:LPC-S, NCC
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:KEAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC, NCC
Mailing Address - Street 1:12274B ASHLEY DR
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-2759
Mailing Address - Country:US
Mailing Address - Phone:228-452-6023
Mailing Address - Fax:228-452-6024
Practice Address - Street 1:12274B ASHLEY DR
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-2759
Practice Address - Country:US
Practice Address - Phone:228-452-6023
Practice Address - Fax:228-452-6024
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MS2096101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02204274Medicaid