Individual
MRS. JACKIE S. KEITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ED.D, LPA, BCBA-D
Contact information
Practice address
440 FM 1247, FOREST, TX 75925
(936) 676-5866
Mailing address
440 FM 1247, FOREST, TX 75925
(936) 676-5866
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
34214
TX
103K00000X
Behavior Analyst
1612
TX
103T00000X
Psychologist
34214
TX
Other
Enumeration date
07/19/2018
Last updated
01/31/2025
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