Provider Demographics
NPI:1891825642
Name:KELLOGG, KEITH (LCSW)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:
Last Name:KELLOGG
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 POLLARD RD,
Mailing Address - Street 2:SUITE B-201
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 POLLARD RD
Practice Address - Street 2:SUITE B-201
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1415
Practice Address - Country:US
Practice Address - Phone:408-356-1414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS17381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical