Provider Demographics
NPI:1649851940
Name:KEERAN, AMY LYNN (COUNSELOR)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:KEERAN
Suffix:
Gender:F
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 CONSERVATORY DR
Mailing Address - Street 2:
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-4291
Mailing Address - Country:US
Mailing Address - Phone:234-334-0303
Mailing Address - Fax:234-334-4832
Practice Address - Street 1:87 CONSERVATORY DR
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-4291
Practice Address - Country:US
Practice Address - Phone:234-334-0303
Practice Address - Fax:234-334-4832
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.174509101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)