Healthcare Provider Details

I. General information

NPI: 1417265067
Provider Name (Legal Business Name): MICHELE ELIZABETH KEHOE MA, QMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 11/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 EXCHANGE ST SUITE 301
ASTORIA OR
97103-3365
US

IV. Provider business mailing address

PO BOX 38
CANNON BEACH OR
97110-0038
US

V. Phone/Fax

Practice location:
  • Phone: 503-325-0241
  • Fax: 503-325-8483
Mailing address:
  • Phone: 503-348-9540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: