Jeane, Martin Keller

Jeane, Martin Keller is an sole proprietor health care provider with primary practice located at 305 Regency Parkway #601, Mansfield TX 76063-7306. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Professional, Behavioral Health & Social Service Providers / Marriage & Family Therapist. Behavioral Health & Social Service Providers / Professional is his primary health care specialty. Jeane, Martin Keller can be contacted via phone (817) 539-0499.

Contact Information

Primary practice address
305 Regency Parkway #601 Mansfield TX 76063-7306
Phone: (817) 539-0499
Fax: (817) 539-0498
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X 08035 Texas
Behavioral Health & Social Service Providers / Marriage & Family Therapist 106H00000X 116 Texas

Profile Details

NPI number 1790863355
LBN Legal business name Jeane, Martin Keller
Credentials PH.D., LPC-S, LMFT
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 1st, 2006
Last updated Aug 10th, 2015 - about 9 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 1790863355 NPPES
Texas Other 052194000 MAGELLAN PROV ID
Texas Other 1017LC MAGELLAN PROV ID
Texas MEDICAID 025581201 MAGELLAN PROV ID
Texas Other 128615 MAGELLAN PROV ID
Texas Other 10029868 MAGELLAN PROV ID
Texas Other 143906 MAGELLAN PROV ID

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