Individual
JAMES W KEENAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, LP
Contact information
Practice address
820 LILAC DR N, SUITE 130, GOLDEN VALLEY, MN 55422-4700
(612) 874-6746
(612) 874-6745
Mailing address
820 LILAC DR N, SUITE 130, GOLDEN VALLEY, MN 55422-4700
(612) 874-6746
(612) 874-6745
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
LP3544
MN
103TP2701X
Group Psychotherapy Psychologist
LP3544
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
118817800
—
MN
01
—
26A04KE
BLUE CROSS BLUE SHIELD
MN
Enumeration date
06/16/2008
Last updated
09/08/2008
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