Provider Demographics
NPI:1477825024
Name:KEY LIFE CONCEPTS LLC
Entity Type:Organization
Organization Name:KEY LIFE CONCEPTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HOUSEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:321-443-8411
Mailing Address - Street 1:22 W MONUMENT AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5192
Mailing Address - Country:US
Mailing Address - Phone:321-443-8411
Mailing Address - Fax:
Practice Address - Street 1:22 W MONUMENT AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5192
Practice Address - Country:US
Practice Address - Phone:321-443-8411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-28
Last Update Date:2012-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 11085251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health