Provider Demographics
NPI:1336451210
Name:KEITH, MARIAN FRANCES
Entity Type:Individual
Prefix:MRS
First Name:MARIAN
Middle Name:FRANCES
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 1:12058 SAN JOSE BLVD STE 703
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-8668
Mailing Address - Country:US
Mailing Address - Phone:904-260-0454
Mailing Address - Fax:904-260-0044
Practice Address - Street 1:12058 SAN JOSE BLVD STE 703
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-8668
Practice Address - Country:US
Practice Address - Phone:904-260-0454
Practice Address - Fax:904-260-0044
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor