Active NPI
Dylan A Keenberg, PSYD
- Clinical Psychologist
- Bellingham, WA
National Provider Identifier
1144652546
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PY60751686
- Practice address
- 1106 Harris Ave Ste 302
Bellingham, WA 98225-7002 - Phone
- (360) 670-0195
- NPI assigned
- Aug 7, 2013
- Last updated
- May 22, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PY60751686 | WA | Primary |
Addresses
Primary practice location
1106 Harris Ave Ste 302
Bellingham, WA 98225-7002
Mailing address
1106 Harris Ave Ste 302
Bellingham, WA 98225-7002
Phone (360) 670-0195
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 4, 2021 through Jan 4, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY60751686 | WA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1375833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1590105600000",
"number": "1144652546",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1106 HARRIS AVE STE 302",
"city": "BELLINGHAM",
"state": "WA",
"postal_code": "982257002",
"telephone_number": "360-670-0195"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1106 HARRIS AVE STE 302",
"city": "BELLINGHAM",
"state": "WA",
"postal_code": "982257002",
"telephone_number": "360-670-0195"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEENBERG",
"first_name": "DYLAN",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-08-07",
"last_updated": "2020-05-22",
"certification_date": "2020-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WA",
"license": "PY60751686",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bellingham, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.