Provider Demographics
NPI:1750936894
Name:JACQUELINE KELLER COUNSELING PLLC
Entity type:Organization
Organization Name:JACQUELINE KELLER COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:M THOMSON
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, NCC
Authorized Official - Phone:248-840-5436
Mailing Address - Street 1:348 KNOLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-1859
Mailing Address - Country:US
Mailing Address - Phone:248-840-5436
Mailing Address - Fax:
Practice Address - Street 1:810 COTTAGEVIEW DR STE 101
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2392
Practice Address - Country:US
Practice Address - Phone:248-840-5436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-06
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health