Provider Demographics
NPI:1639503881
Name:KEYES, JON GODFREY (LPC)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:GODFREY
Last Name:KEYES
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 SE 75TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-1451
Mailing Address - Country:US
Mailing Address - Phone:503-890-3138
Mailing Address - Fax:
Practice Address - Street 1:25 SE 75TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-1451
Practice Address - Country:US
Practice Address - Phone:503-890-3138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3041101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health