Provider Demographics
NPI:1851936256
Name:KEENE, RYAN NATHAN (AMFT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:NATHAN
Last Name:KEENE
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 91251
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93190-1251
Mailing Address - Country:US
Mailing Address - Phone:805-284-4450
Mailing Address - Fax:
Practice Address - Street 1:232 E CANON PERDIDO ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2242
Practice Address - Country:US
Practice Address - Phone:805-963-1433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-10
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA420022EN101YA0400X
CALMFT139547106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)