Basic Information
| Provider Information | |||||||||
| NPI: | 1750721742 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KEEZER | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | MARK | ||||||||
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| Credential: | LMSW, LAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 KENTUCKY ST | ||||||||
| Address2: | |||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660443488 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7857602368 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 MAINE ST STE A | ||||||||
| Address2: | |||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858439192 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2013 | ||||||||
| LastUpdateDate: | 06/12/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 960 | KS | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | 4368 | KS | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.