Provider Demographics
NPI:1942790977
Name:KELLER, SYDNEY BOONE (MA, PLMHP)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:BOONE
Last Name:KELLER
Suffix:
Gender:F
Credentials:MA, PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 S 70TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1567
Mailing Address - Country:US
Mailing Address - Phone:402-327-9711
Mailing Address - Fax:402-475-0380
Practice Address - Street 1:1530 S 70TH ST STE 102
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1567
Practice Address - Country:US
Practice Address - Phone:402-327-9711
Practice Address - Fax:402-475-0380
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11470101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health