Provider Demographics
NPI:1417265067
Name:KEHOE, MICHELE ELIZABETH (MA, QMHP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:ELIZABETH
Last Name:KEHOE
Suffix:
Gender:F
Credentials:MA, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:CANNON BEACH
Mailing Address - State:OR
Mailing Address - Zip Code:97110-0038
Mailing Address - Country:US
Mailing Address - Phone:503-348-9540
Mailing Address - Fax:
Practice Address - Street 1:2120 EXCHANGE ST
Practice Address - Street 2:SUITE 301
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3365
Practice Address - Country:US
Practice Address - Phone:503-325-0241
Practice Address - Fax:503-325-8483
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator