Healthcare Provider Details

I. General information

NPI: 1235883539
Provider Name (Legal Business Name): KAY ANN KELLER LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2022
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 N WHEELING AVE
MUNCIE IN
47303-1602
US

IV. Provider business mailing address

2205 N WHEELING AVE
MUNCIE IN
47303-1602
US

V. Phone/Fax

Practice location:
  • Phone: 765-287-1922
  • Fax: 765-287-9017
Mailing address:
  • Phone: 765-287-1922
  • Fax: 765-287-9017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39001518A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: