Healthcare Provider Details

I. General information

NPI: 1538201074
Provider Name (Legal Business Name): MARYKAY KELLER MA COUNSELING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 E CONCORDA DR CONNOLLY MIDDLE SCHOOL
TEMPE AZ
85282
US

IV. Provider business mailing address

4545 E DRY CREEK RD
PHX AZ
85044
US

V. Phone/Fax

Practice location:
  • Phone: 480-967-8933
  • Fax: 480-929-9695
Mailing address:
  • Phone: 480-940-4122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: