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Organization
NORTHEAST KINGDOM TRAUMA INTENSIVES
Active
Organization
NORTHEAST KINGDOM TRAUMA INTENSIVES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JENNIFER LYNN KEITH PHD, LPC, LCHMC, NCC (OWNER/PSYCHOTHERAPIST)
(802) 327-5902
Entity
Organization
Contact information
Practice address
293 PEARL ST STE 101, ST JOHNSBURY, VT 05819-5641
(802) 327-5902
Mailing address
751 CHESTERFIELD HOLW, LYNDONVILLE, VT 05851-8530
(540) 797-5703
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
09/28/2022
Last updated
09/28/2022
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