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General NPI Number Information
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NPI Number | 1154686590
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Entity Type | Individual
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Provider Name | ANISSA NICOLE KEYES MA, LMFT, LICSW
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Gender | Female
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Dates
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Enumeration Date | 07/11/2012
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Last Update Date | 05/08/2018
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Provider Practice Location Address
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Address Line | 1437 MARSHALL AVE # 204
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City | SAINT PAUL
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State | MN
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Zip | 55104-6350
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Country | US
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Telephone | 612-284-8115
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Fax | 763-273-8892
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Provider Business Mailing Address
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Address Line | 3300 COUNTY ROAD 10 STE 204B
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City | BROOKLYN CENTER
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State | MN
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Zip | 55429-3072
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Country | US
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Telephone | 763-447-5573
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Fax | 763-273-8892
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 2538
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 23288
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License Number State | MN
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