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General NPI Number Information
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NPI Number | 1942507579
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Entity Type | Organization
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Legal Business Name | LAURI L KELLER, LMSW
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Dates
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Enumeration Date | 02/16/2011
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Last Update Date | 03/15/2011
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Provider Practice Location Address
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Address Line | 1086 ORNDORF DR
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City | BRIGHTON
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State | MI
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Zip | 48116-2308
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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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Provider Business Mailing Address
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Address Line | 1086 ORNDORF DR
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City | BRIGHTON
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State | MI
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Zip | 48116-2308
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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 | SOCIAL WORKER
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Name | MS. LAURI LYNN KELLER
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Credential | LMSW
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Telephone | 810-423-1008
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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 | 680108821
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License Number State | MI
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