Provider Demographics
NPI:1487481297
Name:KELLER, CASSANDRA ANNE
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:ANNE
Last Name:KELLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12512 GLENCROFT DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2513
Mailing Address - Country:US
Mailing Address - Phone:314-780-5210
Mailing Address - Fax:
Practice Address - Street 1:1701 N COLLINS BLVD STE 235
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3553
Practice Address - Country:US
Practice Address - Phone:972-294-3691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX94334101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health