Jodway, Keith D

Jodway, Keith D is an sole proprietor health care provider with primary practice located at 209 Tanglewood Dr Apt C , Goshen IN 46526-1718. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Mental Health. Behavioral Health & Social Service Providers / Mental Health is his primary health care specialty. Jodway, Keith D can be contacted via phone (574) 220-0220.

Contact Information

Primary practice address
209 Tanglewood Dr Apt C Goshen IN 46526-1718
Phone: (574) 220-0220
Fax: (574) 975-7788
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 00228 Indiana
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 39001485A Indiana

Profile Details

NPI number 1912949413
LBN Legal business name Jodway, Keith D
Credentials LMHC, LCAC
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 11th, 2006
Last updated May 14th, 2019 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1912949413 NPPES
Indiana Other 87000367A LICENSED CLINICAL ADDICTION COUNSELOR
Indiana Other 39001485A LICENSED CLINICAL ADDICTION COUNSELOR

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