Provider Demographics
NPI:1689872863
Name:KELLER, ARNOLD (LMSW)
Entity Type:Individual
Prefix:MR
First Name:ARNOLD
Middle Name:
Last Name:KELLER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 GRISWOLD ST STE 300
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1690
Mailing Address - Country:US
Mailing Address - Phone:248-348-1100
Mailing Address - Fax:248-348-3410
Practice Address - Street 1:640 GRISWOLD ST STE 300
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167
Practice Address - Country:US
Practice Address - Phone:248-348-1100
Practice Address - Fax:248-348-3410
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801013547104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
0Q26463002Medicare PIN