NPIMap

Individual provider Active NPI

James W Keenan, MS, LP

  • Clinical Child & Adolescent Psychologist
  • Golden Valley, MN
National Provider Identifier
1710147418
Registry record updated Sep 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
License
LP3544 Issued in MN
Practice address
820 Lilac Dr N
Suite 130
Golden Valley, MN 55422-4700
Phone
(612) 874-6746
Fax
(612) 874-6745
NPI assigned
Jun 16, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent Psychologist 103TC2200X LP3544 MN Primary
Group Psychotherapy Psychologist 103TP2701X LP3544 MN

Addresses

Primary practice location

820 Lilac Dr N
Suite 130
Golden Valley, MN 55422-4700

Mailing address

820 Lilac Dr N
Suite 130
Golden Valley, MN 55422-4700
Phone (612) 874-6746

Other identifiers 2

IdentifierTypeStateIssuer
26A04KEOtherMNBLUE CROSS BLUE SHIELD
118817800MedicaidMN

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
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
LP3544MNMDGroup Psychotherapy Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Power of Relationships Past Accepting new patients
Por, LLC Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1213574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1220832000000",
    "number": "1710147418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 LILAC DR N",
            "address_2": "SUITE 130",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554224700",
            "telephone_number": "612-874-6746",
            "fax_number": "612-874-6745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 LILAC DR N",
            "address_2": "SUITE 130",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554224700",
            "telephone_number": "612-874-6746",
            "fax_number": "612-874-6745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEENAN",
        "first_name": "JAMES",
        "middle_name": "W",
        "credential": "MS, LP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-16",
        "last_updated": "2008-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "MN",
            "license": "LP3544",
            "primary": true
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "MN",
            "license": "LP3544",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "26A04KE",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "118817800",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Golden Valley, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2008; 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.