Healthcare Provider Details

I. General information

NPI: 1487003331
Provider Name (Legal Business Name): HOLLY ROSE KELLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S JEFFERSON ST STE 109
SPOKANE WA
99204-3144
US

IV. Provider business mailing address

9960 N NEWPORT HWY # 1013
SPOKANE WA
99218-1366
US

V. Phone/Fax

Practice location:
  • Phone: 509-230-5022
  • Fax: 509-230-5022
Mailing address:
  • Phone: 509-230-5022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number101916
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC60682882
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3371745
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCG60639413
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number57104
License Number StateMT
# 6
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61337839
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: