Provider Demographics
NPI:1942744610
Name:KELLER, KATY KARA (LPC)
Entity Type:Individual
Prefix:
First Name:KATY
Middle Name:KARA
Last Name:KELLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:KARA
Other - Last Name:KELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:320 W OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-2716
Mailing Address - Country:US
Mailing Address - Phone:970-310-3406
Mailing Address - Fax:
Practice Address - Street 1:4380 S SYRACUSE ST STE 309
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-2625
Practice Address - Country:US
Practice Address - Phone:970-310-3406
Practice Address - Fax:888-965-4615
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-14
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0011621101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional