Provider Demographics
NPI:1932618600
Name:HAIGHT, KEAGAN LEA
Entity Type:Individual
Prefix:
First Name:KEAGAN
Middle Name:LEA
Last Name:HAIGHT
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 1:2535 KETTNER BLVD STE 1A4
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-1252
Mailing Address - Country:US
Mailing Address - Phone:619-615-0701
Mailing Address - Fax:
Practice Address - Street 1:2535 KETTNER BLVD STE 1A4
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-1252
Practice Address - Country:US
Practice Address - Phone:619-615-0701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAZLF150058259OtherREGENCE