Doctor Name: | TRACIE LYNN KELLER |
NPI Number: | 1003160219 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPCC-S |
License Number: | E.0900503 |
Business Practice Address: | 1080 Fishinger Rd Suite 103 Columbus, OH - 432212302 |
Business Phone Number: | 6148227819 |
Business Fax Number: | 6143725590 |
Mailing Address: | 1080 Fishinger Rd, Suite 103 COLUMBUS |
State: | OH |
Postal Code: | 432212302 |
Phone Number: | 6148227819 |
Fax Number: | 6143725590 |
NPI Enumeration Date: | 11/09/2012 |
NPI Last Update Date: | 03/12/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | E.0900503 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |