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General NPI Number Information
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NPI Number | 1184130882
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Entity Type | Organization
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Legal Business Name | KEYSTONE COUNSELING, LLC
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Dates
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Enumeration Date | 12/18/2017
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Last Update Date | 12/18/2017
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Provider Practice Location Address
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Address Line | 1219 MILLENNIUM PKWY STE 113
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City | BRANDON
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State | FL
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Zip | 33511-3891
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Country | US
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Telephone | 813-409-3847
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Fax |
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Provider Business Mailing Address
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Address Line | 1219 MILLENNIUM PKWY STE 113
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City | BRANDON
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State | FL
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Zip | 33511-3891
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Country | US
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Telephone | 813-651-4673
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Fax | 813-651-4673
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DIANA MARIE KEONE
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Credential |
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Telephone | 813-651-4673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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