MEDICARE: MR. KEITH M IRWIN MA, QMHP

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	101Y00000X	Counselor	C4798	OR

General Provider Information

NPI Number	:	1932345139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEITH M IRWIN MA, QMHP

Provider Business Mailing Address
First Line	:	2001 COMMERCIAL ST SE # 200
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-5207
Country	:	US
Telephone Number	:	503-370-8050
Fax Number	:	503-370-9982

Provider Business Practice Location Address
First Line	:	2001 COMMERCIAL ST SE # 200
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-5207
Country	:	US
Telephone Number	:	503-370-8050
Fax Number	:	503-370-9982

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

Provider Enumeration Date	:	12/18/2008
Last Update Date	:	03/18/2026

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