Provider Demographics
NPI:1952415119
Name:VENNUM, KEITH (LMHC)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:VENNUM
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E ROBINSON ST
Mailing Address - Street 2:UNIT 2201
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-1695
Mailing Address - Country:US
Mailing Address - Phone:863-529-8491
Mailing Address - Fax:321-247-6983
Practice Address - Street 1:150 E ROBINSON ST UNIT 2201
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-4360
Practice Address - Country:US
Practice Address - Phone:407-205-8833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11014101YM0800X
FLME24611207LA0401X, 2084A0401X, 2084P0800X, 2084P0802X
FLMH 11014101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL68002AOtherMEDICARE
FL003353900Medicaid