Doctor Name: | MRS. KRISTINA D KELLER |
NPI Number: | 1194923532 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | P0308030 |
Business Practice Address: | 141 Diamond Pointe Dr Maumelle, AR - 721136027 |
Business Phone Number: | 5013520708 |
Business Fax Number: | |
Mailing Address: | 141 Diamond Pointe Dr, MAUMELLE |
State: | AR |
Postal Code: | 721136027 |
Phone Number: | 5013520708 |
Fax Number: | |
NPI Enumeration Date: | 07/06/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | P0308030 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AR |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |