Individual
MAXINE LYNN KELLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCADC, CADC
Contact information
Practice address
102 PASCO ST, BEREA, KY 40403-1529
(859) 200-3894
Mailing address
102 PASCO ST, BEREA, KY 40403-1529
(859) 200-3894
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
166100
KY
101YA0400X
Addiction (Substance Use Disorder) Counselor
ADCADC00220812
KY
Other
Enumeration date
01/06/2016
Last updated
08/04/2017
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