Provider Demographics
NPI:1902808579
Name:KELLER, CARLENE RAE (LMHP)
Entity Type:Individual
Prefix:MS
First Name:CARLENE
Middle Name:RAE
Last Name:KELLER
Suffix:
Gender:F
Credentials:LMHP
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Mailing Address - Street 1:907 WEST L STREET
Mailing Address - Street 2:CARLENE KELLER, LMHP COUNSELING SERVICES
Mailing Address - City:MC COOK
Mailing Address - State:NE
Mailing Address - Zip Code:69001-3537
Mailing Address - Country:US
Mailing Address - Phone:308-345-7062
Mailing Address - Fax:308-345-7062
Practice Address - Street 1:907 WEST L STREET
Practice Address - Street 2:CARLENE KELLER, LMHP COUNSELING SERVICES
Practice Address - City:MC COOK
Practice Address - State:NE
Practice Address - Zip Code:69001-3537
Practice Address - Country:US
Practice Address - Phone:308-345-7062
Practice Address - Fax:308-345-7062
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE1561101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE84846OtherBLUE CROSS BLUE SHIELD NE