MEDICARE: LIAM G KEITH

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	:	1699386540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIAM G KEITH

Provider Business Mailing Address
First Line	:	8915 SW CENTER ST
Second Line	:
City	:	TIGARD
State	:	OR
Zip	:	97223-6307
Country	:	US
Telephone Number	:	503-726-3690
Fax Number	:

Provider Business Practice Location Address
First Line	:	4315 N GANTENBEIN AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-2905
Country	:	US
Telephone Number	:	541-601-8209
Fax Number	:

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

Provider Enumeration Date	:	08/13/2020
Last Update Date	:	09/27/2020

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Directions to “ LIAM G KEITH ” Practice Location

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