Provider Demographics
NPI:1629861158
Name:KELLER, EMILY MARIE
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:MARIE
Last Name:KELLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20397 W 220TH TER
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:KS
Mailing Address - Zip Code:66083-4081
Mailing Address - Country:US
Mailing Address - Phone:913-244-6195
Mailing Address - Fax:
Practice Address - Street 1:20397 W 220TH TER
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:KS
Practice Address - Zip Code:66083-4081
Practice Address - Country:US
Practice Address - Phone:913-244-6195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLPC04794101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional