Provider Demographics
NPI:1457058331
Name:KELLER, KYLEE (LPC-ASSOCIATE)
Entity Type:Individual
Prefix:MS
First Name:KYLEE
Middle Name:
Last Name:KELLER
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6540 ALLIANCE DR STE 120
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-0059
Mailing Address - Country:US
Mailing Address - Phone:469-640-0846
Mailing Address - Fax:
Practice Address - Street 1:6540 ALLIANCE DR STE 120
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-0059
Practice Address - Country:US
Practice Address - Phone:469-640-0846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90778101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional