Provider Demographics
NPI:1184873432
Name:KEPPE, JASON FREDERICK
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:FREDERICK
Last Name:KEPPE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 WARD ST
Mailing Address - Street 2:APT. #2
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1158
Mailing Address - Country:US
Mailing Address - Phone:510-848-1443
Mailing Address - Fax:
Practice Address - Street 1:8750 MOUNTAIN BLVD
Practice Address - Street 2:BUILDING 69
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-4500
Practice Address - Country:US
Practice Address - Phone:510-898-8102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2011-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 50069106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist