MEDICARE: COLLABORATIVE SOLUTIONS BY DR. NIKKI KEEFER & ASSOCIATES, INC

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	103K00000X	Behavior Analyst
2	101YM0800X	Mental Health Counselor
3	101YP2500X	Professional Counselor
4	106H00000X	Marriage & Family Therapist
5	101Y00000X	Counselor	MH10896	FL
6	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	685758296	OTHER	FL	MEDWAIVER DD
2	685758298	OTHER	FL	MEDWAIVER HCBS

General Provider Information

NPI Number	:	1619111630
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLABORATIVE SOLUTIONS BY DR. NIKKI KEEFER & ASSOCIATES, INC

Provider Business Mailing Address
First Line	:	4541 ALRIX DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839-3160
Country	:	US
Telephone Number	:	407-489-2121
Fax Number	:	407-352-2026

Provider Business Practice Location Address
First Line	:	4541 ALRIX DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839-3160
Country	:	US
Telephone Number	:	407-489-2121
Fax Number	:	407-352-2026

Authorized Official
Title or Position	:	OWNER
Name	:	DR. NIKKI LYN KEEFER
Credential	:	PH.D, BCBA
Telephone Number	:	407-489-2121

Provider Enumeration Date	:	04/21/2009
Last Update Date	:	12/02/2013

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