Individual
JASON KEATING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1082 WHITETAIL DR, FAIRBORN, OH 45324-8718
(614) 787-3247
Mailing address
1082 WHITETAIL DR, FAIRBORN, OH 45324-8718
(614) 787-3247
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
121035
OH
1041C0700X
Clinical Social Worker
121035
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
351928552
—
IN
Enumeration date
10/01/2015
Last updated
10/01/2015
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