Basic Information
| Provider Information | |||||||||
| NPI: | 1740769496 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KELLER | ||||||||
| FirstName: | TAYLOR | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 BURDICK EXPY E STE 101 | ||||||||
| Address2: | |||||||||
| City: | MINOT | ||||||||
| State: | ND | ||||||||
| PostalCode: | 587015006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013356005 | ||||||||
| FaxNumber: | 7018521190 | ||||||||
| Practice Location | |||||||||
| Address1: | 6301 19TH AVE NW | ||||||||
| Address2: | |||||||||
| City: | MINOT | ||||||||
| State: | ND | ||||||||
| PostalCode: | 587038899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7018523628 | ||||||||
| FaxNumber: | 7018521190 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2018 | ||||||||
| LastUpdateDate: | 02/17/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 964-7-15-18A | ND | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | 964-7-15-18-410 | ND | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.