Provider Demographics
NPI:1912194044
Name:KEENEY, TRISHA LYNN
Entity Type:Individual
Prefix:MISS
First Name:TRISHA
Middle Name:LYNN
Last Name:KEENEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S MILLER ST STE 101102
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-5233
Mailing Address - Country:US
Mailing Address - Phone:805-925-9811
Mailing Address - Fax:805-925-9706
Practice Address - Street 1:201 S MILLER ST STE 101102
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5233
Practice Address - Country:US
Practice Address - Phone:805-925-9811
Practice Address - Fax:805-925-9706
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)