Provider Demographics
NPI:1528401825
Name:KECK, KATIE O'BRIEN (LMFT)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:O'BRIEN
Last Name:KECK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:O'BRIEN
Other - Last Name:ALLRED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:70 SW CENTURY DR STE 100-339
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3557
Mailing Address - Country:US
Mailing Address - Phone:909-533-0375
Mailing Address - Fax:
Practice Address - Street 1:1333 NW 9TH ST
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-1482
Practice Address - Country:US
Practice Address - Phone:541-447-4631
Practice Address - Fax:541-447-2616
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC# 52109106H00000X
ORT1385106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500738169Medicaid