Healthcare Provider Details

I. General information

NPI: 1538099015
Provider Name (Legal Business Name): DENZEL SPECIAL KEEPERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12681 E 79TH ST
INDIANAPOLIS IN
46236-8536
US

IV. Provider business mailing address

12681 E 79TH ST
INDIANAPOLIS IN
46236-8536
US

V. Phone/Fax

Practice location:
  • Phone: 317-722-7377
  • Fax: 701-786-7344
Mailing address:
  • Phone: 317-722-7377
  • Fax: 701-786-7344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DINA KELLY
Title or Position: OWNER
Credential: KELLY
Phone: 317-722-7377