MEDICARE: COLLABORATIVE SOLUTIONS BY DR. NIKKI KEEFER & ASSOC., 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	251S00000X	Community/Behavioral Health Agency	1-01-0516	FL

General Provider Information

NPI Number	:	1962679514
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLABORATIVE SOLUTIONS BY DR. NIKKI KEEFER & ASSOC., 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	:	407-382-2458

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	:	407-382-2458

Authorized Official
Title or Position	:	PRESIDENT, BEHAVIOR ANALYST
Name	:	DR. NIKKI LYNN KEEFER
Credential	:	PHD, BCBA
Telephone Number	:	407-489-2121

Provider Enumeration Date	:	05/13/2008
Last Update Date	:	05/13/2008

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