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Individual

MR. KEITH A. POWELL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
BCABA, CMHP

Contact information

Practice address
5935 23RD ST, VERO BEACH, FL 32966-6403
(772) 794-1367
Mailing address
5935 23RD ST, VERO BEACH, FL 32966-6403
(772) 794-1367

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
171M00000X
Case Manager/Care Coordinator

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
759468200
FL
Enumeration date
08/18/2006
Last updated
05/03/2018
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