Provider Demographics
NPI:1083710057
Name:KELLER, WILLIAM H III (PHD LADC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:H
Last Name:KELLER
Suffix:III
Gender:M
Credentials:PHD LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 SUSAN CIR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1854
Mailing Address - Country:US
Mailing Address - Phone:402-488-2928
Mailing Address - Fax:
Practice Address - Street 1:600 S 70TH ST
Practice Address - Street 2:116
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2451
Practice Address - Country:US
Practice Address - Phone:402-489-3802
Practice Address - Fax:402-486-7872
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE188101YA0400X
NE103103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEKE089715Medicare ID - Type Unspecified