Basic Information
| Provider Information | |||||||||
| NPI: | 1003377672 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEINZ | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9669 SPRUCE MOUNTAIN RD LOT 20 | ||||||||
| Address2: | |||||||||
| City: | LARKSPUR | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801181200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8159781452 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 19585 HESS RD STE 6 | ||||||||
| Address2: | |||||||||
| City: | PARKER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801343891 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7206739132 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2019 | ||||||||
| LastUpdateDate: | 12/28/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 103K00000X | 1-21-57044 | CO | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.