Provider Demographics
NPI:1760530323
Name:KELLER, TERESA D (MA)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:D
Last Name:KELLER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1336
Mailing Address - Street 2:
Mailing Address - City:CRESTONE
Mailing Address - State:CO
Mailing Address - Zip Code:81131-0018
Mailing Address - Country:US
Mailing Address - Phone:719-859-4073
Mailing Address - Fax:
Practice Address - Street 1:1609 SPANISH CREEK RD.
Practice Address - Street 2:
Practice Address - City:CRESTONE
Practice Address - State:CO
Practice Address - Zip Code:81131-9990
Practice Address - Country:US
Practice Address - Phone:719-859-4073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC0005932101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional