Provider Demographics
NPI:1710485057
Name:KELLER, RYAN (MFT)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:KELLER
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2932 240TH ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-8984
Mailing Address - Country:US
Mailing Address - Phone:641-752-3912
Mailing Address - Fax:641-752-3639
Practice Address - Street 1:2932 240TH ST
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-8984
Practice Address - Country:US
Practice Address - Phone:641-752-3912
Practice Address - Fax:641-752-3639
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA089705106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist