Provider Demographics
NPI:1881744787
Name:KELLER, SHARON DONNELLY (MS, LCPC)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:DONNELLY
Last Name:KELLER
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:ANN
Other - Last Name:DONNELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LCPC
Mailing Address - Street 1:50771 PHEASANT COVE DR
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-9500
Mailing Address - Country:US
Mailing Address - Phone:574-524-6307
Mailing Address - Fax:
Practice Address - Street 1:6910 N MAIN ST, UNIT 13C
Practice Address - Street 2:BOX 51
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-9681
Practice Address - Country:US
Practice Address - Phone:574-524-6307
Practice Address - Fax:574-222-1507
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401018507101YM0800X
IL180-004245101YP2500X
IN39002503A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional