Basic Information
| Provider Information | |||||||||
| NPI: | 1336768118 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEELING-TORREZ | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | |||||||||
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| Credential: | RADT | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 9462 VAN NUYS BLVD | ||||||||
| Address2: | |||||||||
| City: | PANORAMA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914021310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188918555 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9462 VAN NUYS BLVD | ||||||||
| Address2: | |||||||||
| City: | PANORAMA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914021310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188918555 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2020 | ||||||||
| LastUpdateDate: | 04/13/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 04/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | R1382880420 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.