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Individual
KEITH VENNUM
Active
Individual
KEITH VENNUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMHC
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MH 11014
FL
101YM0800X
Mental Health Counselor
MH11014
FL
207LA0401X
Addiction Medicine (Anesthesiology) Physician
ME24611
FL
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
ME24611
FL
2084P0800X
Psychiatry Physician
ME24611
FL
2084P0802X
Addiction Psychiatry Physician
ME24611
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003353900
—
FL
01
—
68002A
MEDICARE
FL
Enumeration date
08/17/2006
Last updated
03/29/2021
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