Provider Demographics
NPI:1386043222
Name:KELLERHOUSE, DEAN (LCAC)
Entity Type:Individual
Prefix:MR
First Name:DEAN
Middle Name:
Last Name:KELLERHOUSE
Suffix:
Gender:M
Credentials:LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 LAKE ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3401
Mailing Address - Country:US
Mailing Address - Phone:607-737-5215
Mailing Address - Fax:607-737-5219
Practice Address - Street 1:150 LAKE ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-3401
Practice Address - Country:US
Practice Address - Phone:607-737-5215
Practice Address - Fax:607-737-5219
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-16
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS478101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)