Provider Demographics
NPI:1811745417
Name:MCCANTS, KEILENE
Entity type:Individual
Prefix:
First Name:KEILENE
Middle Name:
Last Name:MCCANTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19506 W MANHATTAN RD
Mailing Address - Street 2:
Mailing Address - City:ELWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60421-9515
Mailing Address - Country:US
Mailing Address - Phone:815-575-0409
Mailing Address - Fax:
Practice Address - Street 1:19506 W MANHATTAN RD
Practice Address - Street 2:
Practice Address - City:ELWOOD
Practice Address - State:IL
Practice Address - Zip Code:60421-9515
Practice Address - Country:US
Practice Address - Phone:815-575-0409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician