Provider Demographics
NPI:1619261047
Name:KELLER, RICHARD LANTZ (LPC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:LANTZ
Last Name:KELLER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1498 S LAREDO ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80017-4003
Mailing Address - Country:US
Mailing Address - Phone:303-906-1138
Mailing Address - Fax:303-753-6498
Practice Address - Street 1:1498 S LAREDO ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80017-4003
Practice Address - Country:US
Practice Address - Phone:303-906-1138
Practice Address - Fax:393-753-6498
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5546101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor