Keller, Tristan Glenn

Keller, Tristan Glenn is an individual health care provider with primary practice located at 2025 E Aztec Ave , Gallup NM 87301-4803. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Keller, Tristan Glenn can be contacted via phone (505) 863-3828.

Contact Information

Primary practice address
2025 E Aztec Ave Gallup NM 87301-4803
Phone: (505) 863-3828
Fax: (505) 863-6612
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X I-05565 New Mexico

Profile Details

NPI number 1053346171
LBN Legal business name Keller, Tristan Glenn
Credentials LISW
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 11th, 2006
Last updated Jul 9th, 2007 - about 18 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 1053346171 NPPES
New Mexico MEDICAID 50526

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