Provider Demographics
NPI:1194163774
Name:RICH, KELLER LEE (LMFT)
Entity type:Individual
Prefix:MS
First Name:KELLER
Middle Name:LEE
Last Name:RICH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5060 SHOREHAM PL STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-5904
Mailing Address - Country:US
Mailing Address - Phone:858-221-0344
Mailing Address - Fax:949-703-7489
Practice Address - Street 1:5060 SHOREHAM PL STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-5904
Practice Address - Country:US
Practice Address - Phone:858-221-0344
Practice Address - Fax:949-703-7489
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95120106H00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program