Healthcare Provider Details

I. General information

NPI: 1003783564
Provider Name (Legal Business Name): KEYLIGHT COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 EXECUTIVE DR STE B
CARMEL IN
46032-2612
US

IV. Provider business mailing address

511 N CHESTER AVE
INDIANAPOLIS IN
46201-2620
US

V. Phone/Fax

Practice location:
  • Phone: 317-674-3121
  • Fax:
Mailing address:
  • Phone: 219-779-0566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTONIO GAETA JR.
Title or Position: THERAPIST
Credential: LCSW
Phone: 219-779-0566