Keller, Charles W

Keller, Charles W is an sole proprietor health care provider with primary practice located at 5502 58Th St Suite 600, Lubbock TX 79414-2000. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Keller, Charles W can be contacted via phone (806) 792-4713.

Contact Information

Primary practice address
5502 58Th St Suite 600 Lubbock TX 79414-2000
Phone: (806) 792-4713
Fax: (806) 792-1506
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 2-0861 Texas

Profile Details

NPI number 1417921693
LBN Legal business name Keller, Charles W
Credentials PH.D.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 15th, 2006
Last updated Jan 4th, 2017 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1417921693 NPPES
Texas MEDICAID 035131401

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