Most Relevant Information
Provider Data
| NPI Number: | 1003065632 |
| Provider Name: | HEATHER KELLER |
| Entity Type: | Individual |
| Taxonomy Code: | 101YP2500X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/18/2008 |
| Last Updated: | 02/15/2021 |
Provider Practice Location
20 E WHITE MOUNTAIN BLVD
LAKESIDE
AZ
859296807
Practice Location Phone/Fax
| Phone: | 4803894519 |
| Fax: |
Provider Mailing Location
20 E WHITE MOUNTAIN BLVD STE A5-118
LAKESIDE
AZ
859296807
Provider Mailing Phone/Fax
| Phone: | 4803894519 |
| Fax: | 4806377570 |