Provider Demographics
NPI:1992163844
Name:SUE KELLER COUNSELING LLC
Entity type:Organization
Organization Name:SUE KELLER COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:217-607-9256
Mailing Address - Street 1:505 W UNIVERSITY AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-3915
Mailing Address - Country:US
Mailing Address - Phone:217-607-9256
Mailing Address - Fax:
Practice Address - Street 1:505 W UNIVERSITY AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-3915
Practice Address - Country:US
Practice Address - Phone:217-607-9256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-07
Last Update Date:2016-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.018211251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health