Provider Demographics
NPI:1811513203
Name:KEIM, HARUE ISHII (MA)
Entity type:Individual
Prefix:
First Name:HARUE
Middle Name:ISHII
Last Name:KEIM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 W 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-3408
Mailing Address - Country:US
Mailing Address - Phone:720-556-9225
Mailing Address - Fax:
Practice Address - Street 1:1080 W 6TH AVE
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-3408
Practice Address - Country:US
Practice Address - Phone:720-556-9225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2023-12-29
Deactivation Date:2023-10-10
Deactivation Code:
Reactivation Date:2023-12-28
Provider Licenses
StateLicense IDTaxonomies
1-23-67611103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst