Provider Demographics
NPI:1538201074
Name:KELLER, MARYKAY (MA COUNSELING)
Entity type:Individual
Prefix:MRS
First Name:MARYKAY
Middle Name:
Last Name:KELLER
Suffix:
Gender:F
Credentials:MA COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 E DRY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PHX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044
Mailing Address - Country:US
Mailing Address - Phone:480-940-4122
Mailing Address - Fax:
Practice Address - Street 1:2002 E CONCORDA DR
Practice Address - Street 2:CONNOLLY MIDDLE SCHOOL
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282
Practice Address - Country:US
Practice Address - Phone:480-967-8933
Practice Address - Fax:480-929-9695
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
569931Medicare UPIN