Provider Demographics
NPI:1982956215
Name:KEELER, KELLY J (MA, LPC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:J
Last Name:KEELER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 BELGIAN CT
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1156
Mailing Address - Country:US
Mailing Address - Phone:970-402-0046
Mailing Address - Fax:
Practice Address - Street 1:2600 BELGIAN CT
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-1156
Practice Address - Country:US
Practice Address - Phone:970-316-3001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 102L00000X, 103K00000X
CO0012117101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst