Provider Demographics
NPI:1154199339
Name:KEEL, CYNTHIA RENIA
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:RENIA
Last Name:KEEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:RENIA
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P O BOX 198870
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-8870
Mailing Address - Country:US
Mailing Address - Phone:773-980-9955
Mailing Address - Fax:
Practice Address - Street 1:6564 S YALE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-3834
Practice Address - Country:US
Practice Address - Phone:773-738-0599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral