Basic Information
| Provider Information | |||||||||
| NPI: | 1174765242 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KEELER | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | ANDERSEN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9400 ZANE AVE N | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN PARK | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554431814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7637628800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6363 FRANCE AVE S | ||||||||
| Address2: | STE 200 | ||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554352129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9522309100 | ||||||||
| FaxNumber: | 9522222525 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2009 | ||||||||
| LastUpdateDate: | 07/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 2352 | MN | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.