Basic Information
| Provider Information | |||||||||
| NPI: | 1083267264 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEIL | ||||||||
| FirstName: | HILARY | ||||||||
| MiddleName: | |||||||||
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| Credential: | AMFT, APCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1414 MADISON ST | ||||||||
| Address2: | |||||||||
| City: | TUSTIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927821782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4437631466 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3785 S PLAZA DR | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927047463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148282000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2019 | ||||||||
| LastUpdateDate: | 07/17/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6377 | CA | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YM0800X | 112195 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.