Provider Demographics
NPI:1699419325
Name:KELLER COUNSELING AND COACHING, LLC
Entity type:Organization
Organization Name:KELLER COUNSELING AND COACHING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:J
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-238-2525
Mailing Address - Street 1:211 E CUSTER ST
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55355-3618
Mailing Address - Country:US
Mailing Address - Phone:218-329-9412
Mailing Address - Fax:
Practice Address - Street 1:211 E CUSTER ST
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55355-3618
Practice Address - Country:US
Practice Address - Phone:218-329-9412
Practice Address - Fax:320-373-5056
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KELLER COUNSELING AND COACHING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1689063547Medicaid
MN1174267272Medicaid