Provider Demographics
NPI:1073656807
Name:KELLER, MICHELLE MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MARIE
Last Name:KELLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:MARIE
Other - Last Name:KELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:7441 O ST STE 402
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2466
Mailing Address - Country:US
Mailing Address - Phone:402-483-4215
Mailing Address - Fax:402-483-5228
Practice Address - Street 1:7441 O ST STE 402
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2466
Practice Address - Country:US
Practice Address - Phone:402-483-4215
Practice Address - Fax:402-483-5228
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE65491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical