Provider Demographics
NPI:1801181623
Name:MUNDAY-KELLER, EDWINA CHARLOTTE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:EDWINA
Middle Name:CHARLOTTE
Last Name:MUNDAY-KELLER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:EDWINA
Other - Middle Name:CHARLOTTE
Other - Last Name:MUNDAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:4572 FLAMING RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-7925
Mailing Address - Country:US
Mailing Address - Phone:702-726-1828
Mailing Address - Fax:
Practice Address - Street 1:3230 S BUFFALO DR STE 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2506
Practice Address - Country:US
Practice Address - Phone:702-410-9090
Practice Address - Fax:888-337-4551
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NV3191106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator