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General NPI Number Information
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NPI Number | 1407939473
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Entity Type | Individual
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Provider Name | JASON KELLER PSY D
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Gender | Male
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 8915 STONE GREEN WAY STE 200
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City | LOUISVILLE
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State | KY
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Zip | 40220-4130
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Country | US
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Telephone | 502-322-4884
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Fax | 502-423-0337
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Provider Business Mailing Address
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Address Line | 8915 STONE GREEN WAY STE 200
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City | LOUISVILLE
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State | KY
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Zip | 40220-4130
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Country | US
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Telephone | 502-322-4884
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Fax | 502-423-0337
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 130799
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 271776
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License Number State | KY
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