Provider Demographics
NPI:1891358487
Name:KEENEY, JUSTIN (LPCC-S)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:KEENEY
Suffix:
Gender:M
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 GRAHAM RD STE 3
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-1155
Mailing Address - Country:US
Mailing Address - Phone:330-606-9262
Mailing Address - Fax:234-678-4858
Practice Address - Street 1:3757 FISHCREEK RD
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-5404
Practice Address - Country:US
Practice Address - Phone:330-606-9262
Practice Address - Fax:330-606-9262
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2303315-SUPV101YP2500X
OHC.2103161101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0354586Medicaid