Healthcare Provider Details

I. General information

NPI: 1073656807
Provider Name (Legal Business Name): MICHELLE MARIE KELLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE MARIE KELLER LICSW

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 01/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7441 O ST STE 402
LINCOLN NE
68510-2466
US

IV. Provider business mailing address

7441 O ST STE 402
LINCOLN NE
68510-2466
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-4215
  • Fax: 402-483-5228
Mailing address:
  • Phone: 402-483-4215
  • Fax: 402-483-5228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6549
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: