Provider Demographics
NPI:1194923532
Name:KELLER, KRISTINA D (LPC)
Entity type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:D
Last Name:KELLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 DIAMOND POINTE DR
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-6027
Mailing Address - Country:US
Mailing Address - Phone:501-352-0708
Mailing Address - Fax:
Practice Address - Street 1:141 DIAMOND POINTE DR
Practice Address - Street 2:
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113-6027
Practice Address - Country:US
Practice Address - Phone:501-352-0708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0308030101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional