Provider Demographics
NPI:1851746796
Name:KEIZUR, HEATHER A (LMFT INTERN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:A
Last Name:KEIZUR
Suffix:
Gender:F
Credentials:LMFT INTERN
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:A
Other - Last Name:NEILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 82819
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97282-0819
Mailing Address - Country:US
Mailing Address - Phone:503-233-5405
Mailing Address - Fax:
Practice Address - Street 1:1815 SW MARLOW AVE STE 218
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5187
Practice Address - Country:US
Practice Address - Phone:503-444-4862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-28
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist