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General NPI Number Information
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NPI Number | 1497770259
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Entity Type | Individual
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Provider Name | DR. KEITH HACKETT
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Gender | Male
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 426 E FOURTH PLAIN BLVD #11
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City | VANCOUVER
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State | WA
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Zip | 98663-3040
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Country | US
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Telephone | 360-696-1615
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Fax | 360-696-2395
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Provider Business Mailing Address
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Address Line | 5001 NW COLUMBIA ST
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City | VANCOUVER
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State | WA
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Zip | 98663-1621
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LF00001437
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License Number State | WA
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