Provider Demographics
NPI:1871178806
Name:KEENAN, CASSIDY STORM (MS, LMFT)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:STORM
Last Name:KEENAN
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7305 W 9TH PL APT 11
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80214-4833
Mailing Address - Country:US
Mailing Address - Phone:806-382-7960
Mailing Address - Fax:
Practice Address - Street 1:7305 W 9TH PL APT 11
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214-4833
Practice Address - Country:US
Practice Address - Phone:806-382-7960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204757106H00000X
COMFT.0002701106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty