Provider Demographics
NPI:1861622300
Name:KEYS, ANDREA D (LADC)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:D
Last Name:KEYS
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6000 BASS LAKE ROAD
Mailing Address - Street 2:SUITE #201
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55429-2794
Mailing Address - Country:US
Mailing Address - Phone:612-578-7901
Mailing Address - Fax:612-600-6956
Practice Address - Street 1:6000 BASS LAKE ROAD
Practice Address - Street 2:SUITE #201
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55429
Practice Address - Country:US
Practice Address - Phone:612-578-7901
Practice Address - Fax:612-600-6956
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302219101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN302219OtherLICENSE NUMBER