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General NPI Number Information
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NPI Number | 1225260565
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Entity Type | Organization
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Legal Business Name | JIM R. KELLER, PH.D., SPECIALISTS IN PSYCHOLOGICAL COUNSELING & CONSUL
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Dates
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Enumeration Date | 08/20/2009
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Last Update Date | 04/01/2021
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Provider Practice Location Address
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Address Line | 1800 RENAISSANCE BLVD 2ND FLOOR
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City | EDMOND
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State | OK
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Zip | 73013-3023
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Country | US
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Telephone | 405-359-2481
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Fax | 405-359-2487
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Provider Business Mailing Address
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Address Line | PO BOX 7083
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City | EDMOND
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State | OK
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Zip | 73083-7083
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Country | US
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Telephone | 405-359-2481
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Fax | 405-359-2487
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Authorized Official
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Title or Position | OWNER, PSYCHOLOGIST
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Name | DR. JAMES RILEY KELLER
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Credential | PH.D.
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Telephone | 405-359-2481
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 854
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License Number State | OK
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