Provider Demographics
NPI:1629125703
Name:KELLER, CURT (LMFT)
Entity Type:Individual
Prefix:
First Name:CURT
Middle Name:
Last Name:KELLER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 RAINBOW DR
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-2427
Mailing Address - Country:US
Mailing Address - Phone:309-353-5792
Mailing Address - Fax:309-353-4393
Practice Address - Street 1:2 RAINBOW DR
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-2427
Practice Address - Country:US
Practice Address - Phone:309-353-5792
Practice Address - Fax:309-353-4393
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist