Provider Demographics
NPI:1801953427
Name:KELLER, HAROLD RICHARD (LCSW)
Entity type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:RICHARD
Last Name:KELLER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16602 ROSE BAY TRL
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-4934
Mailing Address - Country:US
Mailing Address - Phone:302-547-9957
Mailing Address - Fax:800-851-1417
Practice Address - Street 1:16602 ROSE BAY TRL
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-4934
Practice Address - Country:US
Practice Address - Phone:302-547-9957
Practice Address - Fax:800-851-1417
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX552241041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
017371C89Medicare ID - Type Unspecified