Provider Demographics
NPI:1104391358
Name:KEYES, ANIKA (MA)
Entity Type:Individual
Prefix:MS
First Name:ANIKA
Middle Name:
Last Name:KEYES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:ANIKA
Other - Middle Name:K
Other - Last Name:FAIR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:PO BOX 480
Mailing Address - Street 2:
Mailing Address - City:LABADIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70372-0480
Mailing Address - Country:US
Mailing Address - Phone:985-714-4246
Mailing Address - Fax:
Practice Address - Street 1:4266 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:LA
Practice Address - Zip Code:70359-6421
Practice Address - Country:US
Practice Address - Phone:985-714-4246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
LA6453101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator