Provider Demographics
NPI:1346618295
Name:KELLER, NATASHA ANN (MA, PLMHP, NCC)
Entity Type:Individual
Prefix:MRS
First Name:NATASHA
Middle Name:ANN
Last Name:KELLER
Suffix:
Gender:F
Credentials:MA, PLMHP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W 29TH ST STE 320
Mailing Address - Street 2:
Mailing Address - City:SOUTH SIOUX CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68776-3870
Mailing Address - Country:US
Mailing Address - Phone:712-574-4357
Mailing Address - Fax:402-412-2010
Practice Address - Street 1:1000 W 29TH ST STE 320
Practice Address - Street 2:
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-3870
Practice Address - Country:US
Practice Address - Phone:712-574-4357
Practice Address - Fax:402-412-2010
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10650101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor