Individual
KEENAN RAY TOM SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
776 S STATE ST STE 107, UKIAH, CA 95482-5858
(707) 463-4915
Mailing address
776 S STATE ST STE 107, UKIAH, CA 95482-5858
(707) 463-4915
Taxonomy
Speciality
Code
Description
License number
State
225C00000X
Rehabilitation Counselor
Primary
—
—
Other
Enumeration date
11/17/2020
Last updated
11/17/2020
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