Provider Demographics
NPI:1457249211
Name:WINDSOR, KEITH ALAN
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:ALAN
Last Name:WINDSOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:991 HINDMAN CV
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-3829
Mailing Address - Country:US
Mailing Address - Phone:901-440-7767
Mailing Address - Fax:
Practice Address - Street 1:991 HINDMAN CV
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-3829
Practice Address - Country:US
Practice Address - Phone:901-440-7767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000-2373175T00000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No175T00000XOther Service ProvidersPeer Specialist