Healthcare Provider Details

I. General information

NPI: 1063832392
Provider Name (Legal Business Name): KEY BEHAVIOR ESSENTIALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2014
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18425 NW 2ND AVE 310
MIAMI FL
33169-4534
US

IV. Provider business mailing address

18425 NW 2ND AVE 310
MIAMI FL
33169-4534
US

V. Phone/Fax

Practice location:
  • Phone: 954-557-9075
  • Fax: 336-464-2227
Mailing address:
  • Phone: 954-557-9075
  • Fax: 336-464-2227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: QUINTIN BEARD
Title or Position: ADMINISTRATIVE DIRECTOR
Credential:
Phone: 954-557-9075