Provider Demographics
NPI:1861868002
Name:KELLER, REYNA (LCSW)
Entity type:Individual
Prefix:
First Name:REYNA
Middle Name:
Last Name:KELLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7940 FRONT BEACH RD STE 95267
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407-4817
Mailing Address - Country:US
Mailing Address - Phone:305-680-6581
Mailing Address - Fax:
Practice Address - Street 1:1245 DAVID PORTER RD APT B
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-7784
Practice Address - Country:US
Practice Address - Phone:305-680-6581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VACADC1363101YA0400X
VA09040134131041C0700X
FLSW189441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)