Provider Demographics
NPI:1912459504
Name:HEWITT, KEITH JR (LLPC)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:
Last Name:HEWITT
Suffix:JR
Gender:M
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5568 SUSAN AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-5820
Mailing Address - Country:US
Mailing Address - Phone:269-267-6565
Mailing Address - Fax:
Practice Address - Street 1:5568 SUSAN AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-5820
Practice Address - Country:US
Practice Address - Phone:269-267-6565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-29
Last Update Date:2016-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015748101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional