Active NPI
Keoni Sablan
- Mental Health Counselor
- Queen Creek, AZ
National Provider Identifier
1154970648
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 15974
- Practice address
- 22515 E Munoz St
Queen Creek, AZ 85142-9152 - Phone
- (209) 585-0395
- NPI assigned
- Sep 6, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 133337 | CA | |
| Mental Health Counselor | 101YM0800X | 15974 | AZ | Primary |
Addresses
Primary practice location
22515 E Munoz St
Queen Creek, AZ 85142-9152
Mailing address
22515 E Munoz St
Queen Creek, AZ 85142-9152
Phone (209) 596-3873
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 133337 | CA | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Serviam, LLC | Mental Health | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Health Counselor
- Queen Creek, AZ
- NPI 1346028370
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1567728000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695168000000",
"number": "1154970648",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22515 E MUNOZ ST",
"city": "QUEEN CREEK",
"state": "AZ",
"postal_code": "851429152",
"telephone_number": "209-596-3873"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22515 E MUNOZ ST",
"city": "QUEEN CREEK",
"state": "AZ",
"postal_code": "851429152",
"telephone_number": "209-585-0395"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SABLAN",
"first_name": "KEONI",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-09-06",
"last_updated": "2023-09-20",
"certification_date": "2023-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "133337",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "AZ",
"license": "15974",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Queen Creek, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.