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General NPI Number Information
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NPI Number | 1669656153
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Entity Type | Individual
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Provider Name | LAURI LYNN KELLER LMSW
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Gender | Female
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Dates
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Enumeration Date | 12/20/2007
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Last Update Date | 06/29/2020
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Provider Practice Location Address
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Address Line | 3820 PACKARD ST STE 160
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City | ANN ARBOR
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State | MI
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Zip | 48108-5000
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Country | US
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Telephone | 810-423-1008
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Fax | 734-997-5055
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Provider Business Mailing Address
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Address Line | 976 DEVONSHIRE CT
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City | BRIGHTON
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State | MI
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Zip | 48116-1707
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Country | US
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Telephone | 810-423-1008
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Fax | 810-225-2474
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801088821
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License Number State | MI
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