Provider Demographics
NPI:1548327158
Name:EINFELDT, KEITH TIMOTHY (LCSW)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:TIMOTHY
Last Name:EINFELDT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 S COVE DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-8229
Mailing Address - Country:US
Mailing Address - Phone:435-865-1188
Mailing Address - Fax:
Practice Address - Street 1:115 N MAIN ST STE 204
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-2674
Practice Address - Country:US
Practice Address - Phone:435-865-1188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT271304-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical