MEDICARE: MRS. BARBARA KELLER LCMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0680000053	VT

General Provider Information

NPI Number	:	1285797290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BARBARA KELLER LCMHC

Provider Business Mailing Address
First Line	:	187 SAINT PAUL ST
Second Line	:
City	:	BURLINGTON
State	:	VT
Zip	:	05401-4689
Country	:	US
Telephone Number	:	802-899-2967
Fax Number	:

Provider Business Practice Location Address
First Line	:	187 SAINT PAUL ST
Second Line	:
City	:	BURLINGTON
State	:	VT
Zip	:	05401-4689
Country	:	US
Telephone Number	:	802-899-2967
Fax Number	:	802-865-0534

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	07/08/2007

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