Provider Demographics
NPI:1366925273
Name:KELLER, DANIELLE (LMHC)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:KELLER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:CHACKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:5840 LAKESHORE DRIVE
Mailing Address - Street 2:BUILDING 3 UNIT 115
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-6435
Mailing Address - Country:US
Mailing Address - Phone:954-618-8477
Mailing Address - Fax:954-698-2021
Practice Address - Street 1:5840 LAKESHORE DRIVE
Practice Address - Street 2:BUILDING 3 UNIT 115
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-6435
Practice Address - Country:US
Practice Address - Phone:954-618-8477
Practice Address - Fax:954-698-2021
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2024-11-27
Deactivation Date:2021-09-09
Deactivation Code:
Reactivation Date:2023-09-28
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FLMH22704101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician