Provider Demographics
NPI:1598270837
Name:KEY, RITA E (PHD)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:E
Last Name:KEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5490 BROADWAY STE L-11
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-1663
Mailing Address - Country:US
Mailing Address - Phone:773-615-9627
Mailing Address - Fax:
Practice Address - Street 1:5490 BROADWAY STE L-11
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-1663
Practice Address - Country:US
Practice Address - Phone:773-615-9627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty