Provider Demographics
NPI:1497770259
Name:HACKETT, KEITH
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:HACKETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 NW COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-1621
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:426 E FOURTH PLAIN BLVD
Practice Address - Street 2:#11
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3040
Practice Address - Country:US
Practice Address - Phone:360-696-1615
Practice Address - Fax:360-696-2395
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00001437106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist