Healthcare Provider Details

I. General information

NPI: 1689094328
Provider Name (Legal Business Name): VERONICA KEYS LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 04/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 E CEDAR AVE
GLADWIN MI
48624-2215
US

IV. Provider business mailing address

3921 GETTYSBURG ST
MIDLAND MI
48642-5871
US

V. Phone/Fax

Practice location:
  • Phone: 989-426-9295
  • Fax:
Mailing address:
  • Phone: 585-509-0427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6801096423
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: