| Doctor Name: | CARL SCOTT KELLER |
| NPI Number: | 1164899969 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | ED.S. |
| License Number: | 21137164 |
| Business Practice Address: | 4142 Gore Rd Conneaut, OH - 440302918 |
| Business Phone Number: | 4408130958 |
| Business Fax Number: | |
| Mailing Address: | 4200 State Rd, ASHTABULA |
| State: | OH |
| Postal Code: | 440046017 |
| Phone Number: | 4405769023 |
| Fax Number: | |
| NPI Enumeration Date: | 08/27/2015 |
| NPI Last Update Date: | 08/27/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TS0200X |
| License Number: | 21137164 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |