Provider Demographics
NPI:1831633676
Name:CHASE, KEELEY DIANE MILLER (LPC)
Entity type:Individual
Prefix:
First Name:KEELEY
Middle Name:DIANE MILLER
Last Name:CHASE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KEELEY
Other - Middle Name:DIANE MILLER
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:281 LACLAIR ST
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2988
Mailing Address - Country:US
Mailing Address - Phone:541-266-6700
Mailing Address - Fax:541-888-8726
Practice Address - Street 1:281 LACLAIR ST
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2988
Practice Address - Country:US
Practice Address - Phone:541-266-6700
Practice Address - Fax:541-888-8726
Is Sole Proprietor?:No
Enumeration Date:2016-12-13
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health