Provider Demographics
NPI:1649584509
Name:KEELEY, STEPHEN (MS, LPC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:KEELEY
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 E BURNSIDE ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1677
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2304 E BURNSIDE ST
Practice Address - Street 2:SUITE 202
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1677
Practice Address - Country:US
Practice Address - Phone:503-228-9229
Practice Address - Fax:503-228-9558
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2662101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional