Healthcare Provider Details

I. General information

NPI: 1497258735
Provider Name (Legal Business Name): YVONNE KELLER MA, CLT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 03/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 CLAREWOOD DR
HOUSTON TX
77036-4400
US

IV. Provider business mailing address

PO BOX 740745
HOUSTON TX
77274-0745
US

V. Phone/Fax

Practice location:
  • Phone: 979-337-9027
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: