Individual
KEITH KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L.M.S.W
Contact information
Practice address
928 MAIN ST, KEOKUK, IA 52632-4655
(319) 524-4397
Mailing address
928 MAIN ST, KEOKUK, IA 52632-4655
(319) 524-4397
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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