Provider Demographics
NPI:1164004479
Name:KEELER, SYDNEY (MSED, LPCC)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:KEELER
Suffix:
Gender:F
Credentials:MSED, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 VERNON AVE S APT 309
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436-2330
Mailing Address - Country:US
Mailing Address - Phone:612-322-9255
Mailing Address - Fax:
Practice Address - Street 1:5346 LYNDALE AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55419-1230
Practice Address - Country:US
Practice Address - Phone:612-746-5888
Practice Address - Fax:612-746-5518
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4157101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional