Provider Demographics
NPI:1265586507
Name:BETH KEEN PHD PLLC
Entity type:Organization
Organization Name:BETH KEEN PHD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETHANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KEEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:480-430-0192
Mailing Address - Street 1:9001 E SAN VICTOR DR UNIT 1024
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5385
Mailing Address - Country:US
Mailing Address - Phone:480-430-0192
Mailing Address - Fax:
Practice Address - Street 1:10149 N 92ND ST STE 103
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4557
Practice Address - Country:US
Practice Address - Phone:480-430-0192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2021-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3344103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ113043Medicare PIN