Provider Demographics
NPI:1578179727
Name:KELLER, NATASHA ANN (LMFT)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:ANN
Last Name:KELLER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2179 4TH ST STE 2F
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-3041
Mailing Address - Country:US
Mailing Address - Phone:651-360-1995
Mailing Address - Fax:651-666-1379
Practice Address - Street 1:2179 4TH ST STE 2F
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3041
Practice Address - Country:US
Practice Address - Phone:651-360-1995
Practice Address - Fax:651-666-1379
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3651106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist