Provider Demographics
NPI:1578099875
Name:DENNIS, KEELAN
Entity type:Individual
Prefix:
First Name:KEELAN
Middle Name:
Last Name:DENNIS
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 1:35511 BRABHAM RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:OR
Mailing Address - Zip Code:97455-9657
Mailing Address - Country:US
Mailing Address - Phone:541-844-9706
Mailing Address - Fax:
Practice Address - Street 1:35511 BRABHAM RD
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:OR
Practice Address - Zip Code:97455-9657
Practice Address - Country:US
Practice Address - Phone:541-844-9706
Practice Address - Fax:888-472-4050
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-04
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor