Provider Demographics
NPI:1437955689
Name:KELLER, SAMUEL RAY (PEER SUPPORT)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:RAY
Last Name:KELLER
Suffix:
Gender:M
Credentials:PEER SUPPORT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:964 SE TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-4330
Mailing Address - Country:US
Mailing Address - Phone:909-533-9377
Mailing Address - Fax:
Practice Address - Street 1:1939 NE DIAMOND LAKE BLVD
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-3573
Practice Address - Country:US
Practice Address - Phone:541-957-5646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist