Dominik Lia Keller, PHD

Primary specialty

School PsychologistTaxonomy code 103TS0200X

License

621149 Issued in MS

Practice address

5915 Getwell Rd BLDG B
Southaven, MS 38672-6455

Phone

(662) 349-2979

NPI assigned

Mar 29, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Journey to New Beginnings, PLLC

  • Clinical Social Worker
  • Southaven, MS
  • NPI 1891959318
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1648512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671062400000",
    "number": "1710627922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5915 GETWELL RD BLDG B",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386726455",
            "telephone_number": "662-349-2979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5915 GETWELL RD BLDG B",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386726455",
            "telephone_number": "662-349-2979"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "41 Pacella Park Dr",
            "address_purpose": "LOCATION",
            "city": "Randolph",
            "state": "MA",
            "postal_code": "023681755",
            "country_code": "US",
            "telephone_number": "781-437-1381",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLER",
        "first_name": "DOMINIK",
        "middle_name": "LIA",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-29",
        "last_updated": "2022-12-15",
        "certification_date": "2022-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "MS",
            "license": "621149",
            "primary": true
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200000200",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110026265E",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Harleen Kaur
• Ashley Keaton, RBT
• Margaret Kedia, DPT,PHD
• Alexandria Tran Keene, M.D.
• Keep on Smiling Pediatric and General Dentistry PLLC
• Kelly Velasquez Psychiatric Mental Health Nurse Practitioner, LLC
• Patrick John Kelly, DC
• Richard Allen Kelly, M.D.
• Teresa D Kendrick, NP
• Zachary Lee Kennedy, P.T.

• School Psychologist in Southaven, MS
• Providers in Southaven, MS by specialty
• School Psychologist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.