MEDICARE: KEO SENGSAVANG MA, LPCC, LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	2883	MN

General Provider Information

NPI Number	:	1063965721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEO SENGSAVANG MA, LPCC, LMHC

Provider Business Mailing Address
First Line	:	34990 EMERALD COAST PKWY STE 356
Second Line	:
City	:	DESTIN
State	:	FL
Zip	:	32541-8662
Country	:	US
Telephone Number	:	612-234-1823
Fax Number	:

Provider Business Practice Location Address
First Line	:	34990 EMERALD COAST PKWY STE 356
Second Line	:
City	:	DESTIN
State	:	FL
Zip	:	32541-8662
Country	:	US
Telephone Number	:	612-234-1823
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2016
Last Update Date	:	05/05/2026

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