Individual ProviderJai Bea KellerCounselorBehavioral Health & Social Service ProvidersPractice Address86 Boston Ave, Medford, MA 02155-3522(781) 488-3503PECOS EnrollmentBased on the most recent information from CMS, provider Jai Bea Keller does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 10:04 AM.Profile DetailsProvider ID1285772897Provider TypeIndividualFull NameKeller, Jai BeaCredentialL.M.H.C.GenderFemaleSole ProprietorYesEnumeration Date2/3/2007Last Updated7/8/2007Contact InformationPractice LocationPractice Address86 Boston Ave, Medford, MA 02155-3522Phone(781) 488-3503Fax(781) 483-2221Mailing LocationMailing Address86 Boston Ave, Medford, MA 02155-3522Phone(781) 488-3503Fax(781) 483-2221Provider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicense#1354MassachusettsProvider IdentifiersIDDescriptionIssuerID#1354DescriptionOtherIssuerL.M.H.C.Massachusetts