Provider Demographics
NPI:1942366042
Name:KEITH, BRIAN A (DOCTORATE IN PSYCHOL)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:A
Last Name:KEITH
Suffix:
Gender:M
Credentials:DOCTORATE IN PSYCHOL
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 623
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29622-0623
Mailing Address - Country:US
Mailing Address - Phone:864-261-9221
Mailing Address - Fax:
Practice Address - Street 1:1216 ELLA ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-4839
Practice Address - Country:US
Practice Address - Phone:864-261-9221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC602103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPSO199Medicaid