Provider Demographics
NPI:1710286927
Name:KELLER, AMY S
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:S
Last Name:KELLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 GROVE ST # 300
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-5890
Mailing Address - Country:US
Mailing Address - Phone:513-727-1438
Mailing Address - Fax:513-727-1532
Practice Address - Street 1:1001 GROVE ST # 300
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-5890
Practice Address - Country:US
Practice Address - Phone:513-727-1438
Practice Address - Fax:513-727-1532
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH944146101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)