Basic Information
| Provider Information | |||||||||
| NPI: | 1790155737 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KELLER | ||||||||
| FirstName: | ZOE | ||||||||
| MiddleName: | AMELIA | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 170762 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787170034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6619935367 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4614 N INTERSTATE 35 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787513401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129789100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2015 | ||||||||
| LastUpdateDate: | 04/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 81494 | CA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 67754 | TX | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.