| Doctor Name: | MR. JOHN W KELLER |
| NPI Number: | 1043248800 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD |
| License Number: | PY2338 |
| Business Practice Address: | 215 Mountain Dr Ste. 106 Destin, FL - 325412346 |
| Business Phone Number: | 8508379100 |
| Business Fax Number: | 8508373774 |
| Mailing Address: | 215 Mountain Dr, Ste. 106 DESTIN |
| State: | FL |
| Postal Code: | 325412346 |
| Phone Number: | 8508379100 |
| Fax Number: | 8508373774 |
| NPI Enumeration Date: | 06/29/2006 |
| NPI Last Update Date: | 06/22/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | PY2338 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |