Provider Demographics
NPI:1699651117
Name:GREENWELL, KEISHA (MASTERS)
Entity type:Individual
Prefix:
First Name:KEISHA
Middle Name:
Last Name:GREENWELL
Suffix:
Gender:F
Credentials:MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:673 S 300 E
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-3512
Mailing Address - Country:US
Mailing Address - Phone:435-590-1166
Mailing Address - Fax:
Practice Address - Street 1:260 W SAINT GEORGE BLVD
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3727
Practice Address - Country:US
Practice Address - Phone:435-590-1166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4892106-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical