Provider Demographics
NPI:1861773210
Name:KELLER, KARLA CRISTINE (LMSW)
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:CRISTINE
Last Name:KELLER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-5053
Mailing Address - Country:US
Mailing Address - Phone:575-437-7404
Mailing Address - Fax:575-439-2860
Practice Address - Street 1:1900 10TH ST
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-5053
Practice Address - Country:US
Practice Address - Phone:575-437-7404
Practice Address - Fax:575-439-2860
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-077791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM53152042Medicaid