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General NPI Number Information
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NPI Number | 1063832392
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Entity Type | Organization
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Legal Business Name | KEY BEHAVIOR ESSENTIALS
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Dates
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Enumeration Date | 04/25/2014
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Last Update Date | 03/23/2017
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Provider Practice Location Address
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Address Line | 18425 NW 2ND AVE 310
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City | MIAMI
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State | FL
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Zip | 33169-4534
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Country | US
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Telephone | 954-557-9075
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Fax | 336-464-2227
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Provider Business Mailing Address
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Address Line | 18425 NW 2ND AVE 310
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City | MIAMI
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State | FL
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Zip | 33169-4534
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Country | US
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Telephone | 954-557-9075
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Fax | 336-464-2227
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | QUINTIN BEARD
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Credential |
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Telephone | 954-557-9075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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