Provider Demographics
NPI:1255938619
Name:KELLER, DANA S (LMHC)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:S
Last Name:KELLER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:S
Other - Last Name:TREASURE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:19201 120TH AVE NE STE 108
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-9523
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19201 120TH AVE NE STE 108
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-9523
Practice Address - Country:US
Practice Address - Phone:425-485-6541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health