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General NPI Number Information
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NPI Number | 1831337567
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Entity Type | Individual
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Provider Name | CHEDRA LYNN KELLER LPC
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Gender | Female
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Dates
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Enumeration Date | 02/03/2009
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Last Update Date | 02/03/2009
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Provider Practice Location Address
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Address Line | 615 SE FRANK PHILLIPS BLVD
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City | BARTLESVILLE
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State | OK
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Zip | 74003-3918
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Country | US
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Telephone | 918-336-1188
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Fax | 918-336-2933
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Provider Business Mailing Address
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Address Line | 615 SE FRANK PHILLIPS BLVD
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City | BARTLESVILLE
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State | OK
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Zip | 74003-3918
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Country | US
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Telephone | 918-336-1188
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Fax | 918-336-2933
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC 2362
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License Number State | OK
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