Provider Demographics
NPI:1720421977
Name:KEYES, SANDRA A (LMFT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:A
Last Name:KEYES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 GRAND AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2582
Mailing Address - Country:US
Mailing Address - Phone:651-294-2307
Mailing Address - Fax:651-233-5641
Practice Address - Street 1:333 GRAND AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2582
Practice Address - Country:US
Practice Address - Phone:651-294-2307
Practice Address - Fax:651-233-5641
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1819106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist