Provider Demographics
NPI:1457671323
Name:KELLER, BARBARA JOAN (MS)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:JOAN
Last Name:KELLER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:J
Other - Last Name:MEALEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:10905 NE 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-5523
Mailing Address - Country:US
Mailing Address - Phone:360-574-5884
Mailing Address - Fax:
Practice Address - Street 1:10905 NE 11TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-5523
Practice Address - Country:US
Practice Address - Phone:360-574-5884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00039293101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAKD7OJOOtherPROVIDENCE