Provider Demographics
NPI:1184893570
Name:KEITH, JUDY
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:KEITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 ABRAMS RD
Mailing Address - Street 2:SUITE 221
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-5578
Mailing Address - Country:US
Mailing Address - Phone:214-298-2984
Mailing Address - Fax:972-686-5378
Practice Address - Street 1:1221 ABRAMS RD
Practice Address - Street 2:SUITE 221
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-5578
Practice Address - Country:US
Practice Address - Phone:214-298-2984
Practice Address - Fax:972-686-5378
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17253101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional