Provider Demographics
NPI:1821717752
Name:KELLERHALS, BLAKE JOSEPH
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:JOSEPH
Last Name:KELLERHALS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 E CITRUS DR
Mailing Address - Street 2:
Mailing Address - City:FARMERSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93223-1274
Mailing Address - Country:US
Mailing Address - Phone:559-592-2010
Mailing Address - Fax:
Practice Address - Street 1:571 E CITRUS DR
Practice Address - Street 2:
Practice Address - City:FARMERSVILLE
Practice Address - State:CA
Practice Address - Zip Code:93223-1274
Practice Address - Country:US
Practice Address - Phone:559-592-2010
Practice Address - Fax:559-730-2991
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator