Provider Demographics
NPI:1114576048
Name:KELLER, ANGELA M (LPC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:KELLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2780 S JONES BLVD STE 100A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5625
Mailing Address - Country:US
Mailing Address - Phone:702-820-3061
Mailing Address - Fax:702-935-0008
Practice Address - Street 1:10 SOUTH LOS ROBLES COURT
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606
Practice Address - Country:US
Practice Address - Phone:484-599-2640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCP2927-R101YM0800X
PAPCO11656101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health