Provider Demographics
NPI:1558929133
Name:KELLERSTRASS COUNSELING LTD
Entity Type:Organization
Organization Name:KELLERSTRASS COUNSELING LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:KELLERSTRASS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:309-678-5713
Mailing Address - Street 1:320 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-1616
Mailing Address - Country:US
Mailing Address - Phone:309-321-8762
Mailing Address - Fax:
Practice Address - Street 1:320 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-1616
Practice Address - Country:US
Practice Address - Phone:309-321-8762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty