Healthcare Provider Details

I. General information

NPI: 1699419325
Provider Name (Legal Business Name): KELLER COUNSELING AND COACHING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E CUSTER ST
LITCHFIELD MN
55355-3618
US

IV. Provider business mailing address

211 E CUSTER ST
LITCHFIELD MN
55355-3618
US

V. Phone/Fax

Practice location:
  • Phone: 218-329-9412
  • Fax: 320-373-5056
Mailing address:
  • Phone: 218-329-9412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSHUA J KELLER
Title or Position: CEO
Credential:
Phone: 701-238-2525