Provider Demographics
NPI:1326471376
Name:WILLAMETTE VALLEY MENTAL HEALTH, LLC
Entity Type:Organization
Organization Name:WILLAMETTE VALLEY MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GAEDIN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:971-263-7442
Mailing Address - Street 1:161 HIGH ST SE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3660
Mailing Address - Country:US
Mailing Address - Phone:971-263-7442
Mailing Address - Fax:
Practice Address - Street 1:161 HIGH ST SE
Practice Address - Street 2:SUITE 230
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3660
Practice Address - Country:US
Practice Address - Phone:971-263-7442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty