Provider Demographics
NPI:1184955437
Name:KRISTEN L. KEEPORTS, PSYD, LLC
Entity type:Organization
Organization Name:KRISTEN L. KEEPORTS, PSYD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:LARA
Authorized Official - Last Name:KEEPORTS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:717-235-3330
Mailing Address - Street 1:73 E FORREST AVE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:SHREWSBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17361-1400
Mailing Address - Country:US
Mailing Address - Phone:717-235-3330
Mailing Address - Fax:717-235-3377
Practice Address - Street 1:73 E FORREST AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:SHREWSBURY
Practice Address - State:PA
Practice Address - Zip Code:17361-1400
Practice Address - Country:US
Practice Address - Phone:717-235-3330
Practice Address - Fax:717-235-3377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty