Individual
JONATHAN RICHARD KELLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CADAC
Contact information
Practice address
330 E ROOSEVELT ST APT 5008, PHOENIX, AZ 85004-4313
(619) 733-0906
Mailing address
330 E ROOSEVELT ST APT 5008, PHOENIX, AZ 85004-4313
(619) 733-0906
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
CI05830516
CA
Other
Enumeration date
05/19/2016
Last updated
12/20/2023
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