Basic Information
| Provider Information | |||||||||
| NPI: | 1578883526 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KELLER | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | LPC, LCADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 860 NJ-168 | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | TURNERSVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8566177688 | ||||||||
| FaxNumber: | 8564017551 | ||||||||
| Practice Location | |||||||||
| Address1: | 454 HURFFVILLE CROSSKEYS RD | ||||||||
| Address2: | |||||||||
| City: | SEWELL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080802339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8565821419 | ||||||||
| FaxNumber: | 8565827661 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2010 | ||||||||
| LastUpdateDate: | 08/22/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 37PC0021600 | NJ | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | 37PC00021600 | NJ | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.