Provider Demographics
NPI:1952534828
Name:LYKINS, KEITH D (LCDCII)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:D
Last Name:LYKINS
Suffix:
Gender:M
Credentials:LCDCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 COOK RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-9600
Mailing Address - Country:US
Mailing Address - Phone:513-695-1357
Mailing Address - Fax:513-695-2952
Practice Address - Street 1:50 GREENWOOD LN
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-3033
Practice Address - Country:US
Practice Address - Phone:937-746-1154
Practice Address - Fax:937-746-8523
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH091053 (LCDCII)101YA0400X
OH124036 (ICADC(101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)