Provider Demographics
NPI:1063393528
Name:KEELER-WOLF, EVAN CEDAR (AMFT)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:CEDAR
Last Name:KEELER-WOLF
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 LANE CT
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-3129
Mailing Address - Country:US
Mailing Address - Phone:510-384-1468
Mailing Address - Fax:
Practice Address - Street 1:5480 COLLEGE AVE STE 2
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1552
Practice Address - Country:US
Practice Address - Phone:510-336-4646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT157860106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty