Provider Demographics
NPI:1710049861
Name:KELLER, LISA ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANN
Last Name:KELLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-6014
Mailing Address - Country:US
Mailing Address - Phone:408-656-5815
Mailing Address - Fax:408-694-3659
Practice Address - Street 1:315 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-6014
Practice Address - Country:US
Practice Address - Phone:408-656-5815
Practice Address - Fax:408-694-3659
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19547103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist