Provider Demographics
NPI:1578221966
Name:PLEASANTVILLE WELLNESS LLC
Entity Type:Organization
Organization Name:PLEASANTVILLE WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KECK
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:914-943-9672
Mailing Address - Street 1:57 WHEELER AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570-3038
Mailing Address - Country:US
Mailing Address - Phone:917-512-8557
Mailing Address - Fax:
Practice Address - Street 1:57 WHEELER AVE STE 208
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NY
Practice Address - Zip Code:10570-3038
Practice Address - Country:US
Practice Address - Phone:917-512-8557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty