Provider Demographics
NPI:1184095366
Name:KEENS, SUSAN (PHD; MFT)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:KEENS
Suffix:
Gender:F
Credentials:PHD; MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5152 JESSEN DR
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-1329
Mailing Address - Country:US
Mailing Address - Phone:818-929-5246
Mailing Address - Fax:
Practice Address - Street 1:5152 JESSEN DR
Practice Address - Street 2:
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-1329
Practice Address - Country:US
Practice Address - Phone:818-929-5246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-13
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 14029106H00000X
CAPSY 14158103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist