Provider Demographics
NPI:1851696488
Name:KEYT, ELLEN LOUISE (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:LOUISE
Last Name:KEYT
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:DR
Other - First Name:ELLEN
Other - Middle Name:LOUISE
Other - Last Name:FEDON-KEYT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, LP
Mailing Address - Street 1:32380 MARBLEHEAD RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48336-2456
Mailing Address - Country:US
Mailing Address - Phone:313-492-0166
Mailing Address - Fax:
Practice Address - Street 1:COUNSELING & RESOURCE CENTER OF DEARBORN
Practice Address - Street 2:19855 W. OUTER DRIVE
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124
Practice Address - Country:US
Practice Address - Phone:313-359-1977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014137103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical