Healthcare Provider Details

I. General information

NPI: 1639099435
Provider Name (Legal Business Name): WHITNEY KELLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 S MCCLINTOCK DR STE 114
TEMPE AZ
85282-7381
US

IV. Provider business mailing address

1675 E MORTEN AVE UNIT 3117
PHOENIX AZ
85020-4690
US

V. Phone/Fax

Practice location:
  • Phone: 480-530-7581
  • Fax:
Mailing address:
  • Phone: 425-785-5503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: