Provider Demographics
NPI:1043770910
Name:MCKEON COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:MCKEON COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKEON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:203-213-6300
Mailing Address - Street 1:102 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-7368
Mailing Address - Country:US
Mailing Address - Phone:203-213-6300
Mailing Address - Fax:
Practice Address - Street 1:102 RIDGE RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-7368
Practice Address - Country:US
Practice Address - Phone:203-213-6300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty