MEDICARE: SARAH OLIVIA KELLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1962958546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH OLIVIA KELLER

Provider Business Mailing Address
First Line	:	2617 14TH AVE W
Second Line	:	APT. 2
City	:	SEATTLE
State	:	WA
Zip	:	98119-2150
Country	:	US
Telephone Number	:	352-220-0986
Fax Number	:

Provider Business Practice Location Address
First Line	:	2617 14TH AVE WEST
Second Line	:	APT. 2
City	:	SEATTLE
State	:	WA
Zip	:	98119
Country	:	US
Telephone Number	:	352-220-0986
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	09/01/2016

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