Provider Demographics
NPI:1760106744
Name:KELLER CARE LMFT
Entity Type:Organization
Organization Name:KELLER CARE LMFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANNA
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:279-219-9529
Mailing Address - Street 1:700 GIBSON DR APT 1713
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-5762
Mailing Address - Country:US
Mailing Address - Phone:279-219-9529
Mailing Address - Fax:
Practice Address - Street 1:901 SUNRISE AVE.
Practice Address - Street 2:SUITE A3
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661
Practice Address - Country:US
Practice Address - Phone:279-219-9529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization