=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851581250
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KEY COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2007
-----------------------------------------------------
Last Update Date | 07/31/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4134 GULF OF MEXICO DR 208C
-----------------------------------------------------
City | LONGBOAT KEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34228-2612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-228-8084
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2233
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34230-2233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-228-8084
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRINCIPAL
-----------------------------------------------------
Name | ELIZABETH CUPO
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 941-228-2024
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | MH 8909
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------