Healthcare Provider Details

I. General information

NPI: 1619111630
Provider Name (Legal Business Name): COLLABORATIVE SOLUTIONS BY DR. NIKKI KEEFER & ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 12/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4541 ALRIX DR
ORLANDO FL
32839-3160
US

IV. Provider business mailing address

4541 ALRIX DR
ORLANDO FL
32839-3160
US

V. Phone/Fax

Practice location:
  • Phone: 407-489-2121
  • Fax: 407-352-2026
Mailing address:
  • Phone: 407-489-2121
  • Fax: 407-352-2026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMH10896
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. NIKKI LYN KEEFER
Title or Position: OWNER
Credential: PH.D, BCBA
Phone: 407-489-2121