Provider Demographics
NPI:1730395211
Name:KEATING, ALBERT RICHARD (PHD, LCPC)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:RICHARD
Last Name:KEATING
Suffix:
Gender:M
Credentials:PHD, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7N355 RIDGE LINE RD
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-6617
Mailing Address - Country:US
Mailing Address - Phone:630-587-3916
Mailing Address - Fax:
Practice Address - Street 1:7N355 RIDGE LINE RD
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-6617
Practice Address - Country:US
Practice Address - Phone:630-400-0984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180003456101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional