Provider Demographics
NPI:1780821355
Name:KELLER, BETHANY LYNNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:LYNNE
Last Name:KELLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 E 91ST ST STE 316
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1556
Mailing Address - Country:US
Mailing Address - Phone:317-550-3221
Mailing Address - Fax:317-550-3228
Practice Address - Street 1:50 E 91ST ST STE 316
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1556
Practice Address - Country:US
Practice Address - Phone:317-550-3221
Practice Address - Fax:317-550-3228
Is Sole Proprietor?:No
Enumeration Date:2009-01-19
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20043354103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling