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Individual
JASON KELLER
Active
Individual
JASON KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY D
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
271776
KY
103T00000X
Psychologist
Primary
130799
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000540906
ANTHEM
KY
05
—
30605018
—
KY
Enumeration date
10/23/2006
Last updated
10/16/2025
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