Keller, Dominik Lia

Keller, Dominik Lia is an individual health care provider with primary practice located at 5915 Getwell Rd Bldg B , Southaven MS 38672-6455. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / School, Behavioral Health & Social Service Providers / Behavior Technician. Behavioral Health & Social Service Providers / School is her primary health care specialty. Keller, Dominik Lia can be contacted via phone (662) 349-2979.

Contact Information

Primary practice address
5915 Getwell Rd Bldg B Southaven MS 38672-6455
Phone: (662) 349-2979
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / School 103TS0200X 621149 Mississippi
Behavioral Health & Social Service Providers / Behavior Technician 106S00000X

Profile Details

NPI number 1710627922
LBN Legal business name Keller, Dominik Lia
Credentials PHD
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 29th, 2022
Last updated Dec 15th, 2022 - about 4 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 1710627922 NPPES
Mississippi MEDICAID 200000200
Mississippi MEDICAID 110026265E

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