Provider Demographics
NPI:1942641790
Name:KEE, BETHANNE (LMSW/LADAC)
Entity Type:Individual
Prefix:
First Name:BETHANNE
Middle Name:
Last Name:KEE
Suffix:
Gender:F
Credentials:LMSW/LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 S RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-6610
Mailing Address - Country:US
Mailing Address - Phone:575-956-8862
Mailing Address - Fax:575-388-2457
Practice Address - Street 1:2311 RANCH CLUB RD
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-7807
Practice Address - Country:US
Practice Address - Phone:575-956-8862
Practice Address - Fax:575-388-2457
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMX-08245104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker