Provider Demographics
NPI:1942507579
Name:LAURI L KELLER, LMSW
Entity Type:Organization
Organization Name:LAURI L KELLER, LMSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:810-423-1008
Mailing Address - Street 1:1086 ORNDORF DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-2308
Mailing Address - Country:US
Mailing Address - Phone:810-423-1008
Mailing Address - Fax:810-225-2474
Practice Address - Street 1:1086 ORNDORF DR
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-2308
Practice Address - Country:US
Practice Address - Phone:810-423-1008
Practice Address - Fax:810-225-2474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801088211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty