Provider Demographics
NPI:1871088047
Name:KEELS, EDWARD A (CADC-CAS C20311214)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:A
Last Name:KEELS
Suffix:
Gender:M
Credentials:CADC-CAS C20311214
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 F ST FL 2
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-6303
Mailing Address - Country:US
Mailing Address - Phone:619-239-9691
Mailing Address - Fax:619-239-0909
Practice Address - Street 1:1081 CAMINO DEL RIO S
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3542
Practice Address - Country:US
Practice Address - Phone:619-297-5131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC20311214101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)