Healthcare Provider Details

I. General information

NPI: 1538982103
Provider Name (Legal Business Name): AUSTIN COLE KEEVER CADC-1
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20343 DANNY CT
OREGON CITY OR
97045-8619
US

IV. Provider business mailing address

20343 DANNY CT
OREGON CITY OR
97045-8619
US

V. Phone/Fax

Practice location:
  • Phone: 503-449-3412
  • Fax:
Mailing address:
  • Phone: 503-449-3412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number23-03-10658
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: