Provider Demographics
NPI:1538568639
Name:WILLIAM VALLEY MENTAL HEALTH LLC
Entity type:Organization
Organization Name:WILLIAM VALLEY MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GAEDIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:971-263-7442
Mailing Address - Street 1:161 HIGH ST SE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3660
Mailing Address - Country:US
Mailing Address - Phone:971-263-7442
Mailing Address - Fax:
Practice Address - Street 1:161 HIGH ST SE
Practice Address - Street 2:SUITE 230
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3660
Practice Address - Country:US
Practice Address - Phone:971-263-7442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0834106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty