Healthcare Provider Details

I. General information

NPI: 1609369271
Provider Name (Legal Business Name): KEY WELLNESS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2018
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 BOULDER CRESCENT ST STE 102
COLORADO SPRINGS CO
80903
US

IV. Provider business mailing address

10 BOULDER CRESCENT ST STE 102
COLORADO SPRINGS CO
80903-3350
US

V. Phone/Fax

Practice location:
  • Phone: 337-718-8041
  • Fax:
Mailing address:
  • Phone: 337-718-8041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. EVELYN JOY FARMER
Title or Position: OWNER
Credential: MS, LPC
Phone: 337-718-8041