1538201074 NPI number — MRS. MARYKAY KELLER MA COUNSELING

Table of content: MRS. MARYKAY KELLER MA COUNSELING (NPI 1538201074)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538201074 NPI number — MRS. MARYKAY KELLER MA COUNSELING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KELLER
Provider First Name:
MARYKAY
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA COUNSELING
Provider Gender Code:
F

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:
1538201074
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4545 E DRY CREEK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85044
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-940-4122
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2002 E CONCORDA DR
Provider Second Line Business Practice Location Address:
CONNOLLY MIDDLE SCHOOL
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-967-8933
Provider Business Practice Location Address Fax Number:
480-929-9695
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YS0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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