Healthcare Provider Details

I. General information

NPI: 1275448755
Provider Name (Legal Business Name): RETTA KELLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RETTA SMITH LPCC

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3091 S JAMAICA CT STE 140
AURORA CO
80014-2647
US

IV. Provider business mailing address

2597 E NICHOLS CIR
CENTENNIAL CO
80122-3425
US

V. Phone/Fax

Practice location:
  • Phone: 720-449-4121
  • Fax:
Mailing address:
  • Phone: 719-251-8554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0024275
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: