Individual
RYAN KEOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7901 BUSTLETON AVE STE 300, PHILADELPHIA, PA 19152-3330
(215) 537-5367
Mailing address
1145 S 18TH ST, PHILADELPHIA, PA 19146-3051
(856) 304-1824
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
MF001009
PA
Other
Enumeration date
04/29/2022
Last updated
04/29/2022
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