Provider Demographics
NPI:1982820387
Name:KEA BEHAVIORAL HEALTH, PC
Entity Type:Organization
Organization Name:KEA BEHAVIORAL HEALTH, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-550-3688
Mailing Address - Street 1:2812 BOSQUE DEL RIO
Mailing Address - Street 2:PO BOX 27482
Mailing Address - City:ALBUQUERQUE, NM 87125
Mailing Address - State:NM
Mailing Address - Zip Code:87125
Mailing Address - Country:US
Mailing Address - Phone:505-550-3688
Mailing Address - Fax:505-343-3130
Practice Address - Street 1:2812 BOSQUE DEL RIO LN NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-3130
Practice Address - Country:US
Practice Address - Phone:505-550-3688
Practice Address - Fax:505-343-3130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty