Provider Demographics
NPI:1922306133
Name:KEEHN, DONNA ANN (MFT79075)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:ANN
Last Name:KEEHN
Suffix:
Gender:F
Credentials:MFT79075
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1337 CAMINO DEL MAR
Mailing Address - Street 2:SUITE C
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-2504
Mailing Address - Country:US
Mailing Address - Phone:424-354-9392
Mailing Address - Fax:888-807-9301
Practice Address - Street 1:1337 CAMINO DEL MAR
Practice Address - Street 2:SUITE C
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-2504
Practice Address - Country:US
Practice Address - Phone:424-354-9392
Practice Address - Fax:888-807-9301
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-11
Last Update Date:2014-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79075106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist