Provider Demographics
NPI:1134983323
Name:KEATING, AVA BRAVATA (LMHCA)
Entity type:Individual
Prefix:MS
First Name:AVA
Middle Name:BRAVATA
Last Name:KEATING
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 S 136TH ST
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98168-2861
Mailing Address - Country:US
Mailing Address - Phone:206-818-1503
Mailing Address - Fax:
Practice Address - Street 1:1227 S 136TH ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98168-2861
Practice Address - Country:US
Practice Address - Phone:206-818-1503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61434160101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health