Active NPI
Keenan Reddish, LMFT
- Marriage & Family Therapist
- Douglasville, GA
National Provider Identifier
1881129625
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- MFT001332
- Practice address
- 8306 Office Park Dr Ste B
Douglasville, GA 30134-6935 - Phone
- (470) 485-2987
- Fax
- (678) 391-8275
- NPI assigned
- May 1, 2017
- 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 |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | MFT001332 | GA | Primary |
Addresses
Primary practice location
8306 Office Park Dr Ste B
Douglasville, GA 30134-6935
Mailing address
8306 Office Park Dr Ste B
Douglasville, GA 30134-6935
Phone (470) 485-2987
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 |
|---|---|---|---|
| MFT001332 | GA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1493596800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1554336000000",
"number": "1881129625",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8306 OFFICE PARK DR STE B",
"city": "DOUGLASVILLE",
"state": "GA",
"postal_code": "301346935",
"telephone_number": "470-485-2987",
"fax_number": "678-391-8275"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8306 OFFICE PARK DR STE B",
"city": "DOUGLASVILLE",
"state": "GA",
"postal_code": "301346935",
"telephone_number": "470-485-2987",
"fax_number": "678-391-8275"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REDDISH",
"first_name": "KEENAN",
"name_prefix": "Mr.",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-05-01",
"last_updated": "2019-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "GA",
"license": "MFT001332",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Douglasville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.