Healthcare Provider Details

I. General information

NPI: 1780410712
Provider Name (Legal Business Name): ANNE MARIE STEPHANIE KEEN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 LEE RD STE 300
WINTER PARK FL
32789-2107
US

IV. Provider business mailing address

1850 LEE RD STE 300
WINTER PARK FL
32789-2107
US

V. Phone/Fax

Practice location:
  • Phone: 407-205-9196
  • Fax:
Mailing address:
  • Phone: 407-205-9196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH27823
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: