=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376299594
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KEYS2HEALING, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2022
-----------------------------------------------------
Last Update Date | 02/25/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 99 E VIRGINIA AVE STE 170
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85004-1124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-367-5291
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4573 N 17TH AVE
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85015-3815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-367-5291
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. SHANIKA TOMS
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 602-367-5291
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------