Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 1041C0700X | Clinical Social Worker |
NPI | 1003159534 |
---|---|
Provider Name | William Edward Keeler |
First Address | Hermiston, OR 97838-6600 |
Second Address | Hermiston, OR 97838-6600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2013 |
Last Update Date | 21/06/2017 |