Provider Demographics
NPI:1821098849
Name:KEY, PERCY (CSW)
Entity Type:Individual
Prefix:MR
First Name:PERCY
Middle Name:
Last Name:KEY
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20540 WINCHESTER
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-3159
Mailing Address - Country:US
Mailing Address - Phone:248-357-0029
Mailing Address - Fax:248-357-0194
Practice Address - Street 1:20540 WINCHESTER ST.
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-3159
Practice Address - Country:US
Practice Address - Phone:248-357-0029
Practice Address - Fax:248-357-0194
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-01
Last Update Date:2015-10-08
Deactivation Date:2014-07-14
Deactivation Code:
Reactivation Date:2015-10-08
Provider Licenses
StateLicense IDTaxonomies
MI68010151821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P13940Medicare ID - Type Unspecified