Basic Information
| Provider Information | |||||||||
| NPI: | 1962892935 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEELS | ||||||||
| FirstName: | TAUREN | ||||||||
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| Credential: | M.ED, LBA, BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2200 CROOKS RD APT 41 | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480845323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2487954939 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 15930 19 MILE RD | ||||||||
| Address2: | STE 201 | ||||||||
| City: | CLINTON TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480381155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5864640175 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2015 | ||||||||
| LastUpdateDate: | 05/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 7401000327 | MI | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.