MEDICARE: MS. BRIGETTE MARIE KEANE MFT

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	106H00000X	Marriage & Family Therapist
2	106H00000X	Marriage & Family Therapist	T0941	OR

General Provider Information

NPI Number	:	1932401916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BRIGETTE MARIE KEANE MFT

Provider Business Mailing Address
First Line	:	10700 SW BEAVERTON HILLSDALE HWY STE 620
Second Line	:
City	:	BEAVERTON
State	:	OR
Zip	:	97005-3037
Country	:	US
Telephone Number	:	503-939-6425
Fax Number	:	888-690-5696

Provider Business Practice Location Address
First Line	:	10700 SW BEAVERTON HILLSDALE HWY STE 620
Second Line	:
City	:	BEAVERTON
State	:	OR
Zip	:	97005-3037
Country	:	US
Telephone Number	:	503-939-6425
Fax Number	:	888-690-5696

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

Provider Enumeration Date	:	11/24/2010
Last Update Date	:	09/23/2024

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