Healthcare Provider Details

I. General information

NPI: 1821948704
Provider Name (Legal Business Name): KEYSTONE MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2026
Last Update Date: 01/30/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 N WICKHAM RD STE 102
MELBOURNE FL
32935-2226
US

IV. Provider business mailing address

2755 N WICKHAM RD STE 102
MELBOURNE FL
32935-2226
US

V. Phone/Fax

Practice location:
  • Phone: 321-613-8632
  • Fax: 321-306-2793
Mailing address:
  • Phone: 321-613-8632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH MATHEW BURTON
Title or Position: OWNER/CLINICAL DIRECTOR
Credential: LMHC
Phone: 321-290-0577