Provider Demographics
NPI:1346898434
Name:KELLER, STEVEN LESLIE (LPC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:LESLIE
Last Name:KELLER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 W ELKHORN AVE
Mailing Address - Street 2:
Mailing Address - City:ESTES PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80517-9128
Mailing Address - Country:US
Mailing Address - Phone:720-202-6020
Mailing Address - Fax:
Practice Address - Street 1:890 W ELKHORN AVE
Practice Address - Street 2:
Practice Address - City:ESTES PARK
Practice Address - State:CO
Practice Address - Zip Code:80517-9128
Practice Address - Country:US
Practice Address - Phone:720-202-6020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-31
Last Update Date:2019-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC15673101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO15763OtherNONE