MEDICARE: MEGAN ELIZABETH KELLER LPC-A

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	101Y00000X	Counselor	10111	SC

General Provider Information

NPI Number	:	1528893310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN ELIZABETH KELLER LPC-A

Provider Business Mailing Address
First Line	:	713 LONG POINT RD
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-8226
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	713 LONG POINT RD
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-8226
Country	:	US
Telephone Number	:	843-901-4459
Fax Number	:

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

Provider Enumeration Date	:	09/03/2024
Last Update Date	:	09/03/2024

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