Jacqueline Keller, LPC
Counselor, Professional in Traverse City, MI. Individual provider (NPI-1).
NPI number1669947115
StatusActive
Last updated in NPPESJan 17, 2021
Details
- NPI
- 1669947115
- Entity type
- Individual (NPI-1)
- Name
- Jacqueline Keller
- Credential
- LPC
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Oct 11, 2018
- Certification date
- Jan 17, 2021
- Last updated
- Jan 17, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YP2500X | Counselor, Professional | 6401007863 | MI | Yes |
Practice location
810 Cottageview Dr Ste 101Traverse City, MI 49684-2392
Phone 231-943-1553
Mailing address
348 Knollwood DrTraverse City, MI 49686-1859
Phone 248-840-5436
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