1225260565 NPI number — JIM R. KELLER, PH.D., SPECIALISTS IN PSYCHOLOGICAL COUNSELING & CONSUL

Table of content: DAVID B. GOLDBERGER MD (NPI 1558327890)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225260565 NPI number — JIM R. KELLER, PH.D., SPECIALISTS IN PSYCHOLOGICAL COUNSELING & CONSUL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JIM R. KELLER, PH.D., SPECIALISTS IN PSYCHOLOGICAL COUNSELING & CONSUL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225260565
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7083
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDMOND
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73083-7083
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-359-2481
Provider Business Mailing Address Fax Number:
405-359-2487

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 RENAISSANCE BLVD
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
EDMOND
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73013-3023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-359-2481
Provider Business Practice Location Address Fax Number:
405-359-2487
Provider Enumeration Date:
08/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
KELLER
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
RILEY
Authorized Official Title or Position:
OWNER, PSYCHOLOGIST
Authorized Official Telephone Number:
405-359-2481

Provider Taxonomy Codes

  • Taxonomy code: 103TC1900X , with the licence number:  854 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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