NPIMap

Individual provider Active NPI

Michael Keenan, LSUDC

  • Addiction (Substance Use Disorder) Counselor
  • St George, UT
National Provider Identifier
1417428178
Registry record updated Dec 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
5649814-6006 Issued in UT
Practice address
1223 S 1280 E
Saint George, UT 84790-8553
Phone
(435) 680-1459
NPI assigned
Dec 6, 2018
Last updated
Dec 6, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 5649814-6006 UT Primary

Addresses

Primary practice location

1223 S 1280 E
Saint George, UT 84790-8553

Mailing address

1223 S 1280 E
Saint George, UT 84790-8553
Phone (435) 680-1459

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

LicenseStateTypeSpecialty
5649814-6006UTMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
High Desert Counseling LLC Current Accepting new patients
Access Foundation Corp. Addiction (Substance Use Disorder) Current Accepting new patients
Access Foundation Corp. Current Accepting new patients
Stable Environment LLC PastSince Dec 16, 2020 Accepting new patients

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1544054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544054400000",
    "number": "1417428178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1223 S 1280 E",
            "city": "SAINT GEORGE",
            "state": "UT",
            "postal_code": "847908553",
            "telephone_number": "435-680-1459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1223 S 1280 E",
            "city": "SAINT GEORGE",
            "state": "UT",
            "postal_code": "847908553",
            "telephone_number": "435-680-1459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEENAN",
        "first_name": "MICHAEL",
        "credential": "LSUDC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-12-06",
        "last_updated": "2018-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "UT",
            "license": "5649814-6006",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St George, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.