Provider Demographics
NPI:1609165026
Name:KEELER, EVELYN B (MFT MU22999)
Entity Type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:B
Last Name:KEELER
Suffix:
Gender:F
Credentials:MFT MU22999
Other - Prefix:
Other - First Name:BYRDIE
Other - Middle Name:
Other - Last Name:KEELER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT MU22999
Mailing Address - Street 1:15 PARK TERRACE
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941
Mailing Address - Country:US
Mailing Address - Phone:415-383-8804
Mailing Address - Fax:
Practice Address - Street 1:15 PARK TERRACE
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941
Practice Address - Country:US
Practice Address - Phone:415-383-8804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMU22999101Y00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist