Provider Demographics
NPI:1831479369
Name:KEETON, GEREMY F (MMFT, LMFT)
Entity Type:Individual
Prefix:MR
First Name:GEREMY
Middle Name:F
Last Name:KEETON
Suffix:
Gender:M
Credentials:MMFT, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 BRAMBLWOOD LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1588
Mailing Address - Country:US
Mailing Address - Phone:719-310-2995
Mailing Address - Fax:
Practice Address - Street 1:2050 BRAMBLWOOD LN
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1588
Practice Address - Country:US
Practice Address - Phone:719-310-2995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YP1600X
CO724106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO27-4224058OtherGK COUNSELING & THERAPEUTIC SERVICES, LLC (REGISTERED IN COLORADO)