Provider Demographics
NPI:1740769496
Name:KELLER, TAYLOR (LPCC)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:KELLER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 BURDICK EXPY E STE 101
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-5006
Mailing Address - Country:US
Mailing Address - Phone:701-335-6005
Mailing Address - Fax:701-852-1190
Practice Address - Street 1:6301 19TH AVE NW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-8899
Practice Address - Country:US
Practice Address - Phone:701-852-3628
Practice Address - Fax:701-852-1190
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND964-7-15-18A101YP2500X
ND964-7-15-18-410101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional