Provider Demographics
NPI:1710169594
Name:KEYS, MARITA ELIZABETH (LPC)
Entity Type:Individual
Prefix:
First Name:MARITA
Middle Name:ELIZABETH
Last Name:KEYS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8383 NE SANDY BLVD
Mailing Address - Street 2:SUITE #205
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-4948
Mailing Address - Country:US
Mailing Address - Phone:503-253-0964
Mailing Address - Fax:503-293-7659
Practice Address - Street 1:8383 NE SANDY BLVD
Practice Address - Street 2:SUITE #205
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-4948
Practice Address - Country:US
Practice Address - Phone:503-253-0964
Practice Address - Fax:503-293-7659
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1563101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional