Provider Demographics
NPI:1598300907
Name:WASHINGTON, KEYUNDA (LMHC)
Entity Type:Individual
Prefix:MS
First Name:KEYUNDA
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2241 N MONROE ST # 1234
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-4731
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1210 E PARK AVE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-2653
Practice Address - Country:US
Practice Address - Phone:850-404-9002
Practice Address - Fax:850-848-6596
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-08
Last Update Date:2022-12-06
Deactivation Date:2019-12-24
Deactivation Code:
Reactivation Date:2020-12-02
Provider Licenses
StateLicense IDTaxonomies
FLMH19651101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty