Provider Demographics
NPI:1902207244
Name:KELLER, SALINA MEECE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:SALINA
Middle Name:MEECE
Last Name:KELLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:SALINA
Other - Middle Name:ANN
Other - Last Name:MEECE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3939 W GREEN OAKS BLVD STE 214
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-2793
Mailing Address - Country:US
Mailing Address - Phone:985-630-9256
Mailing Address - Fax:
Practice Address - Street 1:211 WAYNE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4526
Practice Address - Country:US
Practice Address - Phone:931-223-6394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-05
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN621674308101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3397960Medicaid