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Individual
MR. MARTIN KELLER JEANE
Active
Individual
MR. MARTIN KELLER JEANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D., LPC-S, LMFT
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
08035
TX
106H00000X
Marriage & Family Therapist
116
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
025581201
—
TX
01
—
052194000
MAGELLAN PROV ID
TX
01
—
10029868
AMERIGROUP PROV. ID
TX
01
—
1017LC
BLUE CROSS BLUE SHIELD
TX
01
—
128615
MHN PROVIDER ID
TX
01
—
143906
VALUEOPTIONS ID
TX
Enumeration date
11/01/2006
Last updated
08/26/2026
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