Provider Demographics
NPI:1194351809
Name:KELLER, MICHELLE LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:KELLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4818 BRIDLE BEND WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-4889
Mailing Address - Country:US
Mailing Address - Phone:859-489-6452
Mailing Address - Fax:
Practice Address - Street 1:12701 TOWNEPARK WAY BLDG SUITE200
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-2384
Practice Address - Country:US
Practice Address - Phone:502-254-8880
Practice Address - Fax:502-254-8870
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-14
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY254281101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty