Provider Demographics
NPI:1578866174
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/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMESHULAH
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:PROCTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:919-801-7268
Mailing Address - Street 1:12200 ARNESON ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-6961
Mailing Address - Country:US
Mailing Address - Phone:919-801-7268
Mailing Address - Fax:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health