Basic Information
| Provider Information | |||||||||
| NPI: | 1578157186 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KELLER | ||||||||
| FirstName: | CORRIN | ||||||||
| MiddleName: | REILLEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 287 | ||||||||
| Address2: | |||||||||
| City: | BETHEL | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995590287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075436830 | ||||||||
| FaxNumber: | 9075433454 | ||||||||
| Practice Location | |||||||||
| Address1: | 1360 CALISTA DR. | ||||||||
| Address2: | |||||||||
| City: | BETHEL | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995590287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075436830 | ||||||||
| FaxNumber: | 9075433454 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2021 | ||||||||
| LastUpdateDate: | 02/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.