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General NPI Number Information
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NPI Number | 1750805503
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Entity Type | Organization
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Legal Business Name | KELLER PSYCHOLOGY
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Dates
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Enumeration Date | 08/02/2017
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Last Update Date | 08/02/2017
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Provider Practice Location Address
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Address Line | 3340 LEAHY DR
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City | DALLAS
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State | TX
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Zip | 75229-3852
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Country | US
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Telephone | 479-879-6051
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Fax | 479-879-6051
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Provider Business Mailing Address
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Address Line | 3340 LEAHY DR
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City | DALLAS
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State | TX
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Zip | 75229-3852
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Country | US
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Telephone | 479-879-6051
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Fax |
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Authorized Official
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Title or Position | OWNER/COUNSELOR
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Name | DR. KATHRYN KELLER
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Credential | LPC-S
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Telephone | 479-879-6051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 69060
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License Number State | TX
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