Healthcare Provider Details

I. General information

NPI: 1386623148
Provider Name (Legal Business Name): GARY J KEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 E MAIN ST
AMELIA OH
45102-1993
US

IV. Provider business mailing address

43 E MAIN ST
AMELIA OH
45102-1993
US

V. Phone/Fax

Practice location:
  • Phone: 513-947-7000
  • Fax: 513-947-7222
Mailing address:
  • Phone: 513-947-7000
  • Fax: 513-947-7222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberI0001199
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: