Provider Demographics
NPI:1932128022
Name:KELLER, GINA MARIE (LMFT)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:MARIE
Last Name:KELLER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 W SAN GABRIEL AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93705-0921
Mailing Address - Country:US
Mailing Address - Phone:559-222-7123
Mailing Address - Fax:
Practice Address - Street 1:1451 W SHAW AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3608
Practice Address - Country:US
Practice Address - Phone:559-243-1809
Practice Address - Fax:559-243-1807
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37347106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist