MEDICARE: LAST KEY ON THE RING, PLLC

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	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073165494
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAST KEY ON THE RING, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 88089
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80908-8089
Country	:	US
Telephone Number	:	719-357-1810
Fax Number	:	855-395-0668

Provider Business Practice Location Address
First Line	:	5590 N ACADEMY BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-3616
Country	:	US
Telephone Number	:	719-357-1810
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. TAMARA SHELLEE LATHAM
Credential	:	LCSW
Telephone Number	:	719-357-1810

Provider Enumeration Date	:	07/15/2019
Last Update Date	:	09/24/2024

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