Healthcare Provider Details

I. General information

NPI: 1033367925
Provider Name (Legal Business Name): MICHELE COLLEEN KELLER LAC, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELE COLLEEN COPP LAC, MA

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3687 VETERANS DR
FORT HARRISON MT
59636-9700
US

IV. Provider business mailing address

3687 VETERANS DR
FORT HARRISON MT
59636-9700
US

V. Phone/Fax

Practice location:
  • Phone: 406-447-6000
  • Fax:
Mailing address:
  • Phone: 406-447-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1251
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1405
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: