Provider Demographics
NPI:1932196987
Name:KELLER, THOMAS B (LMHC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:B
Last Name:KELLER
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 E HALLANDALE BEACH BLVD
Mailing Address - Street 2:511-C
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4834
Mailing Address - Country:US
Mailing Address - Phone:954-567-8446
Mailing Address - Fax:954-457-5661
Practice Address - Street 1:2500 E HALLANDALE BEACH BLVD
Practice Address - Street 2:511-C
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4834
Practice Address - Country:US
Practice Address - Phone:954-567-8446
Practice Address - Fax:954-457-5661
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5062101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health