Provider Demographics
NPI:1174116826
Name:KELLER, SHELLIE JO (CPC, CADC-I)
Entity type:Individual
Prefix:DR
First Name:SHELLIE
Middle Name:JO
Last Name:KELLER
Suffix:
Gender:F
Credentials:CPC, CADC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3936 GOLDFIELD ST
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-8106
Mailing Address - Country:US
Mailing Address - Phone:702-862-0943
Mailing Address - Fax:
Practice Address - Street 1:3127 E WARM SPRINGS RD STE 300
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3134
Practice Address - Country:US
Practice Address - Phone:702-850-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-13
Last Update Date:2024-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV06734101YA0400X
NVCP5736101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)