Provider Demographics
NPI:1457030975
Name:MCKELLER, ALECIA
Entity type:Individual
Prefix:
First Name:ALECIA
Middle Name:
Last Name:MCKELLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37520 MOORE DR
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-5635
Mailing Address - Country:US
Mailing Address - Phone:813-335-0665
Mailing Address - Fax:
Practice Address - Street 1:2202 N WEST SHORE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-5749
Practice Address - Country:US
Practice Address - Phone:813-335-0665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician