Provider Demographics
NPI:1366978975
Name:TROTMAN, KEISHA (MS, LMHC)
Entity type:Individual
Prefix:
First Name:KEISHA
Middle Name:
Last Name:TROTMAN
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1590 NW 128TH DR
Mailing Address - Street 2:APT 204
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-5217
Mailing Address - Country:US
Mailing Address - Phone:321-289-9044
Mailing Address - Fax:
Practice Address - Street 1:1590 NW 128TH DR
Practice Address - Street 2:APT 204
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-5217
Practice Address - Country:US
Practice Address - Phone:321-289-9044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11261101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health