Individual
MR. KEITH D JODWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMHC, LCAC
Contact information
Practice address
209 TANGLEWOOD DR APT C, GOSHEN, IN 46526-1718
(574) 220-0220
(574) 975-7788
Mailing address
211 E WASHINGTON ST, GOSHEN, IN 46528-3322
(574) 220-0220
(574) 534-5778
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
00228
IN
101YM0800X
Mental Health Counselor
Primary
39001485A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39001485A
LICENSED MENTAL HEALTH COUNSELOR
IN
01
—
87000367A
LICENSED CLINICAL ADDICTION COUNSELOR
IN
Enumeration date
06/11/2006
Last updated
05/14/2019
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