Provider Demographics
NPI:1760112155
Name:KEILLOR, BRINNA (MC)
Entity Type:Individual
Prefix:
First Name:BRINNA
Middle Name:
Last Name:KEILLOR
Suffix:
Gender:F
Credentials:MC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 SW 13TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3442
Mailing Address - Country:US
Mailing Address - Phone:541-640-3031
Mailing Address - Fax:541-550-1495
Practice Address - Street 1:516 SW 13TH ST STE 201
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3442
Practice Address - Country:US
Practice Address - Phone:541-640-3031
Practice Address - Fax:541-550-1495
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR516897101YS0200X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool