Basic Information
| Provider Information | |||||||||
| NPI: | 1336483437 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KELLER | ||||||||
| FirstName: | KATIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1575 N 4TH ST | ||||||||
| Address2: | #103 | ||||||||
| City: | LARAMIE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820722091 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3077210700 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 920 E SHERIDAN ST STE A | ||||||||
| Address2: | |||||||||
| City: | LARAMIE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820703868 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3074609039 | ||||||||
| FaxNumber: | 3074609041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2012 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 172V00000X | N | Other Service Providers | Community Health Worker | 101YP2500X | LPC-1660 | WY | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.