Provider Demographics
NPI:1801594163
Name:GEDDES, KEENAN
Entity type:Individual
Prefix:
First Name:KEENAN
Middle Name:
Last Name:GEDDES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50207
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84605-0207
Mailing Address - Country:US
Mailing Address - Phone:801-407-4134
Mailing Address - Fax:801-877-0864
Practice Address - Street 1:2989 W MAPLE LOOP DR STE 210
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-7413
Practice Address - Country:US
Practice Address - Phone:801-407-4134
Practice Address - Fax:801-877-0864
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14200411-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health