Healthcare Provider Details

I. General information

NPI: 1780022996
Provider Name (Legal Business Name): JULIA MARIE KELLER MA, LMHC, CDPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-3926
US

IV. Provider business mailing address

1019 PACIFIC AVE STE 300
TACOMA WA
98402-4488
US

V. Phone/Fax

Practice location:
  • Phone: 253-441-4742
  • Fax:
Mailing address:
  • Phone: 253-722-1576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCO60211981
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60304079
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: