Provider Demographics
NPI:1659081941
Name:KEELER, JACOB (LPC)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:KEELER
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 1:1519 N MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-1377
Mailing Address - Country:US
Mailing Address - Phone:269-273-2024
Mailing Address - Fax:269-273-3191
Practice Address - Street 1:1519 N MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-1377
Practice Address - Country:US
Practice Address - Phone:269-273-2024
Practice Address - Fax:269-273-3191
Is Sole Proprietor?:No
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401017891101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional