| Keelan Dennis Mft | |
|
2103 E Washington St Ste 2g Bloomington IL 61701-4365 | |
| (309) 431-1649 | |
| Not Available |
| Full Name | Keelan Dennis Mft |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 2103 E Washington St Ste 2g, Bloomington, Illinois |
| Authorized Official Name and Position | Keelan Dennis (MENTAL HEALTH COUNSELOR) |
| Authorized Official Contact | 3094311649 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Keelan Dennis Mft 2103 E Washington St Ste 2g Bloomington IL 61701-4365 Ph: (309) 431-1649 | Keelan Dennis Mft 2103 E Washington St Ste 2g Bloomington IL 61701-4365 Ph: (309) 431-1649 |
| NPI Number | 1376018770 |
|---|---|
| Provider Enumeration Date | 10/11/2018 |
| Last Update Date | 08/05/2021 |
| Certification Date | 08/05/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376018770 | NPI | - | NPPES |
| 1578099875 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
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