Provider Demographics
NPI:1447588603
Name:KEY BEHAVIOR ESSENTIALS, LLC
Entity Type:Organization
Organization Name:KEY BEHAVIOR ESSENTIALS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/ PROGRAM MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMESHULAH
Authorized Official - Middle Name:PROCTOR
Authorized Official - Last Name:KEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-801-7268
Mailing Address - Street 1:8300 FALLS OF NEUSE RD STE 108
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3450
Mailing Address - Country:US
Mailing Address - Phone:919-846-6800
Mailing Address - Fax:919-846-6807
Practice Address - Street 1:8300 FALLS OF NEUSE RD STE 108
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3450
Practice Address - Country:US
Practice Address - Phone:919-846-6800
Practice Address - Fax:919-846-6807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty