MEDICARE: MR. BRIAN M KELTNER LPC

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	5668	CO

General Provider Information

NPI Number	:	1972897155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRIAN M KELTNER LPC

Provider Business Mailing Address
First Line	:	3615 S TAMARAC DR
Second Line	:	SUITE 310
City	:	DENVER
State	:	CO
Zip	:	80237-1421
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3615 S TAMARAC DR
Second Line	:	SUITE 310
City	:	DENVER
State	:	CO
Zip	:	80237-1421
Country	:	US
Telephone Number	:	719-322-4604
Fax Number	:

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

Provider Enumeration Date	:	06/05/2011
Last Update Date	:	06/05/2011

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