Provider Demographics
NPI:1730646191
Name:SMITH-KELLER, KELEY ANNE (LPC)
Entity Type:Individual
Prefix:DR
First Name:KELEY
Middle Name:ANNE
Last Name:SMITH-KELLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-2120
Mailing Address - Country:US
Mailing Address - Phone:605-670-0407
Mailing Address - Fax:
Practice Address - Street 1:1105 W 8TH ST
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-3725
Practice Address - Country:US
Practice Address - Phone:605-668-1363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC882101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
14411667OtherCAQH