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General NPI Number Information
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NPI Number | 1538568639
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Entity Type | Organization
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Legal Business Name | WILLIAM VALLEY MENTAL HEALTH LLC
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Dates
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Enumeration Date | 08/14/2014
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Last Update Date | 08/14/2014
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Provider Practice Location Address
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Address Line | 161 HIGH ST SE SUITE 230
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City | SALEM
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State | OR
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Zip | 97301-3660
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Country | US
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Telephone | 971-263-7442
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Fax |
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Provider Business Mailing Address
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Address Line | 161 HIGH ST SE SUITE 230
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City | SALEM
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State | OR
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Zip | 97301-3660
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Country | US
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Telephone | 971-263-7442
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GAEDIN A KELLER
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Credential | LMFT
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Telephone | 971-263-7442
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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 | T0834
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License Number State | OR
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