Provider Demographics
NPI:1780957043
Name:ELISABETH KIEFFER ASSESSMENT & CONSULTATION SERVICES
Entity type:Organization
Organization Name:ELISABETH KIEFFER ASSESSMENT & CONSULTATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMHC
Authorized Official - Prefix:
Authorized Official - First Name:ELISABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:KIEFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-292-3710
Mailing Address - Street 1:6681 DABNEY ST
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-1151
Mailing Address - Country:US
Mailing Address - Phone:239-292-3710
Mailing Address - Fax:
Practice Address - Street 1:6681 DABNEY ST
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-1151
Practice Address - Country:US
Practice Address - Phone:239-292-3710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7237101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003585200Medicaid