Individual
DR. WALT KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
HSPP
Contact information
Practice address
645 N WALNUT ST, BLOOMINGTON, IN 47404-3846
(812) 336-3570
(812) 336-9010
Mailing address
PO BOX 11, BLOOMINGTON, IN 47402-0011
(812) 336-3570
(812) 336-9010
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20040042
IN
Other
Enumeration date
04/13/2012
Last updated
04/16/2012
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