Provider Demographics
NPI:1740897909
Name:KEANE, WHITNEY LEIGH (BS, RBT)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:LEIGH
Last Name:KEANE
Suffix:
Gender:F
Credentials:BS, RBT
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:LEIGH
Other - Last Name:WEEKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:4000 SMITHTOWN RD STE 200
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6560
Practice Address - Country:US
Practice Address - Phone:470-632-4990
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-20-130911106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician