MEDICARE: MR. KEITH OVELMEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1538590617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEITH OVELMEN

Provider Business Mailing Address
First Line	:	7210 N OATMAN AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-5836
Country	:	US
Telephone Number	:	503-803-7713
Fax Number	:	503-285-5362

Provider Business Practice Location Address
First Line	:	7210 N OATMAN AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-5836
Country	:	US
Telephone Number	:	503-803-7713
Fax Number	:	503-285-5362

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/27/2013
Last Update Date	:	11/27/2013

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Directions to “ MR. KEITH OVELMEN ” Practice Location

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