Provider Demographics
NPI:1962036483
Name:KEITEL, DEMI (LPC, LCPC)
Entity Type:Individual
Prefix:
First Name:DEMI
Middle Name:
Last Name:KEITEL
Suffix:
Gender:F
Credentials:LPC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3990 PLEASANT VIEW DR NE
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-4030
Mailing Address - Country:US
Mailing Address - Phone:503-602-1007
Mailing Address - Fax:503-994-1692
Practice Address - Street 1:3990 PLEASANT VIEW DR NE
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-4030
Practice Address - Country:US
Practice Address - Phone:503-602-1007
Practice Address - Fax:503-994-1692
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC6499101YM0800X
ORC5592101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health