Provider Demographics
NPI:1720237308
Name:KEENAN, KELLI ANGELA
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:ANGELA
Last Name:KEENAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KELLI
Other - Middle Name:ANGELA
Other - Last Name:SOTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6765 GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-8984
Mailing Address - Country:US
Mailing Address - Phone:530-622-5551
Mailing Address - Fax:
Practice Address - Street 1:6765 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-8984
Practice Address - Country:US
Practice Address - Phone:530-622-5551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor