Provider Demographics
NPI:1609214527
Name:KELTNER, TINA RENE (LLMSW)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:RENE
Last Name:KELTNER
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CARE DR
Mailing Address - Street 2:SUITE 236
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-5054
Mailing Address - Country:US
Mailing Address - Phone:517-439-2622
Mailing Address - Fax:517-437-0110
Practice Address - Street 1:25 CARE DR
Practice Address - Street 2:SUITE 236
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-5054
Practice Address - Country:US
Practice Address - Phone:517-439-2622
Practice Address - Fax:517-437-0110
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker