Provider Demographics
NPI:1003551904
Name:KELLER, OLIVIA COOPER (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:COOPER
Last Name:KELLER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13629 MAPLELEAF CIR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-8525
Mailing Address - Country:US
Mailing Address - Phone:765-748-6209
Mailing Address - Fax:
Practice Address - Street 1:14701 CUMBERLAND RD STE 200
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-3098
Practice Address - Country:US
Practice Address - Phone:765-748-6209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-21-50117103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst