Individual
KIMLY KEETON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, LCAC
Contact information
Practice address
809 JEFFERSON AVE, LA PORTE, IN 46350-3431
(219) 898-5646
Mailing address
2725 BEAUTY CREEK RUN, VALPARAISO, IN 46385-7049
(219) 741-8895
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
87001395A
IN
1041C0700X
Clinical Social Worker
Primary
34006482A
IN
Other
Enumeration date
01/23/2015
Last updated
03/03/2016
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