Provider Demographics
NPI:1659869998
Name:SIMS, KEITH ALLAN JR (BA, CAP)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:ALLAN
Last Name:SIMS
Suffix:JR
Gender:M
Credentials:BA, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 SW 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-3502
Mailing Address - Country:US
Mailing Address - Phone:954-782-9774
Mailing Address - Fax:954-782-3843
Practice Address - Street 1:380 SW 12TH AVE
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-3502
Practice Address - Country:US
Practice Address - Phone:954-782-9774
Practice Address - Fax:954-782-3843
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)