Provider Demographics
NPI:1518672732
Name:KECK, RAQUEL ALEXANDRA
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:ALEXANDRA
Last Name:KECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 LOKER AVE W # 11409
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92010-6603
Mailing Address - Country:US
Mailing Address - Phone:760-450-6767
Mailing Address - Fax:
Practice Address - Street 1:34270 PACIFIC COAST HWY FL 3
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-2847
Practice Address - Country:US
Practice Address - Phone:866-497-2736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA156632106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist