Provider Demographics
NPI:1831546308
Name:KEENAN, MICHAEL (MA MFT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:KEENAN
Suffix:
Gender:M
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 E VICTORIA ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-2619
Mailing Address - Country:US
Mailing Address - Phone:805-563-2714
Mailing Address - Fax:
Practice Address - Street 1:27 E VICTORIA ST
Practice Address - Street 2:SUITE C
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2619
Practice Address - Country:US
Practice Address - Phone:805-563-2714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-15
Last Update Date:2016-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33576106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist