Mr Keenan P Tyner, LCSW is a
Social Worker - Clinical based in Ukiah, California. Mr Keenan P Tyner is licensed to practice in California (license number LCSW101659) and his current practice location is
2240 Old River Rd, Ukiah, California. He can be reached at his office (for appointments etc.) via phone at
(707) 467-5181.
NPI number for Mr Keenan P Tyner is 1023347911 and his current mailing address is 1124 W Standley St, Ukiah, California. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1023347911.
Healthcare Provider's Profile
| Full Name | Mr Keenan P Tyner |
|---|
| Gender | Male |
|---|
| Speciality | Social Worker - Clinical |
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| Location | 2240 Old River Rd, Ukiah, California |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1023347911
- Provider Enumeration Date: 12/23/2009
- Last Update Date: 03/30/2023
Medical Identifiers
Medical identifiers for Mr Keenan P Tyner such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1023347911 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101Y00000X | Counselor | (* (Not Available)) | Secondary |
| 101YM0800X | Counselor - Mental Health | 69833 (California) | Secondary |
| 1041C0700X | Social Worker - Clinical | 69833 (California) | Secondary |
| 171M00000X | Case Manager/care Coordinator | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | LCSW101659 (California) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Keenan P Tyner is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Mr Keenan P Tyner, LCSW
1124 W Standley St,
Ukiah, CA 95482-4231
Ph: (707) 272-5989 | Mr Keenan P Tyner, LCSW
2240 Old River Rd,
Ukiah, CA 95482-6103
Ph: (707) 467-5181 |
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