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Individual
KEITH KELLER
Active
Individual
KEITH KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L.M.S.W
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
075011
IA
101YM0800X
Mental Health Counselor
075011
IA
104100000X
Social Worker
075011
IA
106H00000X
Marriage & Family Therapist
075011
IA
Other
Enumeration date
03/02/2015
Last updated
03/02/2015
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