Provider Demographics
NPI:1447545173
Name:KELLER, CHRISTINE EMILY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:EMILY
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 1:2115 NE WYATT COURT, SUITE 201
Mailing Address - Street 2:VETERANS AFFAIRS CLINIC
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701
Mailing Address - Country:US
Mailing Address - Phone:541-647-5226
Mailing Address - Fax:
Practice Address - Street 1:2115 NE WYATT CT
Practice Address - Street 2:SUITE 201
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7678
Practice Address - Country:US
Practice Address - Phone:541-647-5226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL42621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical