Provider Demographics
NPI:1881995835
Name:THOMAS, KEITH MILAN (QMHP)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:MILAN
Last Name:THOMAS
Suffix:
Gender:M
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 WASHBURN WAY
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-3648
Mailing Address - Country:US
Mailing Address - Phone:541-883-1030
Mailing Address - Fax:541-883-4213
Practice Address - Street 1:725 WASHBURN WAY
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-3730
Practice Address - Country:US
Practice Address - Phone:541-883-1030
Practice Address - Fax:541-883-4213
Is Sole Proprietor?:No
Enumeration Date:2010-11-08
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172V00000XOther Service ProvidersCommunity Health Worker