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General NPI Number Information
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NPI Number | 1750936894
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Entity Type | Organization
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Legal Business Name | JACQUELINE KELLER COUNSELING PLLC
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Dates
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Enumeration Date | 08/06/2019
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Last Update Date | 01/17/2021
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Provider Practice Location Address
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Address Line | 810 COTTAGEVIEW DR STE 101
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-2392
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Country | US
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Telephone | 248-840-5436
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Fax |
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Provider Business Mailing Address
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Address Line | 348 KNOLLWOOD DR
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City | TRAVERSE CITY
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State | MI
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Zip | 49686-1859
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Country | US
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Telephone | 248-840-5436
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | JACQUELINE M THOMSON KELLER
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Credential | MA, NCC
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Telephone | 248-840-5436
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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