Provider Demographics
NPI:1154990315
Name:KEYS, JOSHUA EVANDON (QMHP-A, QMHP-C)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:EVANDON
Last Name:KEYS
Suffix:
Gender:M
Credentials:QMHP-A, QMHP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 JACKS SHOP RD
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE
Mailing Address - State:VA
Mailing Address - Zip Code:22738-4061
Mailing Address - Country:US
Mailing Address - Phone:703-307-6216
Mailing Address - Fax:
Practice Address - Street 1:27 JACKS SHOP RD
Practice Address - Street 2:
Practice Address - City:ROCHELLE
Practice Address - State:VA
Practice Address - Zip Code:22738-4061
Practice Address - Country:US
Practice Address - Phone:703-307-6216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician