Provider Demographics
NPI:1205002433
Name:KEY TO LIFE COUNSELING CENTER
Entity type:Organization
Organization Name:KEY TO LIFE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXCUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:DEMEL
Authorized Official - Last Name:PONTIFLET
Authorized Official - Suffix:
Authorized Official - Credentials:BA, CAC III
Authorized Official - Phone:303-865-3485
Mailing Address - Street 1:14231 EAST 4TH AVE
Mailing Address - Street 2:BLD 0NE SUITE 370
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-9048
Mailing Address - Country:US
Mailing Address - Phone:303-856-3485
Mailing Address - Fax:
Practice Address - Street 1:14231 E 4TH AVE
Practice Address - Street 2:BLD 0NE SUITE 370
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-8734
Practice Address - Country:US
Practice Address - Phone:303-856-3485
Practice Address - Fax:303-856-3175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COADAD #162901251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
COADAD LICENSE #162901OtherADAD LICENSE #162901; CAC III LICENSE #6578