Provider Demographics
NPI:1447510177
Name:KELLER, LEE STEPHEN JR (LMFT, CT)
Entity type:Individual
Prefix:MR
First Name:LEE
Middle Name:STEPHEN
Last Name:KELLER
Suffix:JR
Gender:M
Credentials:LMFT, CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4334 WENDY WAY
Mailing Address - Street 2:
Mailing Address - City:SCHWENKSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19473-2093
Mailing Address - Country:US
Mailing Address - Phone:610-831-1990
Mailing Address - Fax:
Practice Address - Street 1:4334 WENDY WAY
Practice Address - Street 2:
Practice Address - City:SCHWENKSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19473-2093
Practice Address - Country:US
Practice Address - Phone:610-831-1990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000187106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist