Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY29644 | CA |
Y | 103T00000X | Psychologist | PSY29644 | CA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ||
N | 103TC2200X | Clinical Child & Adolescent Psychologist | ||
N | 103TF0000X | Family Psychologist | ||
N | 103TP2701X | Group Psychotherapist |
NPI | 1235647280 |
---|---|
Provider Name | Dr. Mitchell S Keil |
First Address | Newport Beach, CA 92660-3115 |
Second Address | Newport Beach, CA 92660-3115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2018 |
Last Update Date | 20/02/2018 |