Provider Demographics
NPI:1659932408
Name:KEY, MIKEL (DIRECTOR)
Entity Type:Individual
Prefix:
First Name:MIKEL
Middle Name:
Last Name:KEY
Suffix:
Gender:M
Credentials:DIRECTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2261
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71273-2261
Mailing Address - Country:US
Mailing Address - Phone:225-270-6751
Mailing Address - Fax:
Practice Address - Street 1:330 PINE ST
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-3118
Practice Address - Country:US
Practice Address - Phone:318-480-1332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator