MEDICARE: TIMOTHY A KELLER LMFT

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	106H00000X	Marriage & Family Therapist	150697	CA

General Provider Information

NPI Number	:	1497550560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY A KELLER LMFT

Provider Business Mailing Address
First Line	:	8939 E STOCKTON BLVD
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95624-9596
Country	:	US
Telephone Number	:	279-901-2191
Fax Number	:

Provider Business Practice Location Address
First Line	:	8939 E STOCKTON BLVD
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95624-9596
Country	:	US
Telephone Number	:	279-901-2191
Fax Number	:

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

Provider Enumeration Date	:	02/13/2025
Last Update Date	:	02/13/2025

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Directions to “ TIMOTHY A KELLER LMFT” Practice Location

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