Provider Demographics
NPI:1477507838
Name:KELLER, JOE (LCSW LAC)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:
Last Name:KELLER
Suffix:
Gender:M
Credentials:LCSW LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 1ST AVE E
Mailing Address - Street 2:STE 3
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901
Mailing Address - Country:US
Mailing Address - Phone:406-257-3877
Mailing Address - Fax:406-257-3907
Practice Address - Street 1:307 1ST AVE E
Practice Address - Street 2:STE 3
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901
Practice Address - Country:US
Practice Address - Phone:406-257-3877
Practice Address - Fax:406-257-3907
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT951LAC101YA0400X
MT579LCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0502061Medicaid
MT71333OtherBLUE CROSS BLUE SHIELD
MT71333OtherBLUE CROSS BLUE SHIELD