Individual
JIMMY L KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CIT
Contact information
Practice address
2238 1ST ST, SLIDELL, LA 70458-3606
(985) 690-6622
(985) 690-6662
Mailing address
2238 1ST ST, SLIDELL, LA 70458-3606
(985) 690-6622
(985) 690-6662
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
2959
LA
Other
Enumeration date
03/27/2012
Last updated
03/27/2012
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