Provider Demographics
NPI:1518656651
Name:ELMI, KEYSE
Entity Type:Individual
Prefix:
First Name:KEYSE
Middle Name:
Last Name:ELMI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2719 W DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-3822
Mailing Address - Country:US
Mailing Address - Phone:320-828-4205
Mailing Address - Fax:612-465-5056
Practice Address - Street 1:2719 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-3822
Practice Address - Country:US
Practice Address - Phone:320-828-4205
Practice Address - Fax:612-465-5056
Is Sole Proprietor?:No
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician