Provider Demographics
NPI:1912173063
Name:RODNEY C. KELLER PC
Entity Type:Organization
Organization Name:RODNEY C. KELLER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:CARLYLE
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:SR
Authorized Official - Credentials:LCSW, LMFT
Authorized Official - Phone:210-415-4278
Mailing Address - Street 1:1502 BEAUCHAMP ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1210
Mailing Address - Country:US
Mailing Address - Phone:210-415-4278
Mailing Address - Fax:210-757-4030
Practice Address - Street 1:319 E MULBERRY AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-3024
Practice Address - Country:US
Practice Address - Phone:210-415-4278
Practice Address - Fax:210-757-4030
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RODNEY C. KELLER, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX004721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX064191201Medicaid
TX1679654545OtherNPI