Provider Demographics
NPI:1285253526
Name:KELLER, ELISE MARIE (LPCC)
Entity type:Individual
Prefix:MS
First Name:ELISE
Middle Name:MARIE
Last Name:KELLER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:MRS
Other - First Name:ELISE
Other - Middle Name:MARIE
Other - Last Name:NAATZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:315 5TH ST SE APT 304
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-1660
Mailing Address - Country:US
Mailing Address - Phone:763-568-5229
Mailing Address - Fax:
Practice Address - Street 1:14551 JUDICIAL RD STE 100
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-4991
Practice Address - Country:US
Practice Address - Phone:952-898-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2442101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health