Provider Demographics
NPI:1487001871
Name:KELLER, JORDAN DAVID (LPC-MHSP)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:DAVID
Last Name:KELLER
Suffix:
Gender:M
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8720 DAYFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6940
Mailing Address - Country:US
Mailing Address - Phone:423-301-1500
Mailing Address - Fax:
Practice Address - Street 1:8720 DAYFLOWER DR
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-6940
Practice Address - Country:US
Practice Address - Phone:423-301-1500
Practice Address - Fax:423-616-9815
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-16
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health