Provider Demographics
NPI:1235301045
Name:KELLER, JUDY J (LCSW, PIP)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:J
Last Name:KELLER
Suffix:
Gender:F
Credentials:LCSW, PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 LILY FLAGG RD SW
Mailing Address - Street 2:SUITE D
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-3066
Mailing Address - Country:US
Mailing Address - Phone:256-881-5352
Mailing Address - Fax:
Practice Address - Street 1:116 LILY FLAGG RD SW
Practice Address - Street 2:SUITE D
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-3066
Practice Address - Country:US
Practice Address - Phone:256-881-5352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2153C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51549069OtherBCBS