Provider Demographics
NPI:1548465669
Name:KEENER, MARSHA L (MA ATR LPAT)
Entity type:Individual
Prefix:MS
First Name:MARSHA
Middle Name:L
Last Name:KEENER
Suffix:
Gender:F
Credentials:MA ATR LPAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 ROMA AVE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-1942
Mailing Address - Country:US
Mailing Address - Phone:505-248-0898
Mailing Address - Fax:505-842-8497
Practice Address - Street 1:912 ROMA AVE NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-1942
Practice Address - Country:US
Practice Address - Phone:505-248-0898
Practice Address - Fax:505-842-8497
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0134101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health