Provider Demographics
NPI:1538590617
Name:OVELMEN, KEITH
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:
Last Name:OVELMEN
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 1:7210 N OATMAN AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-5836
Mailing Address - Country:US
Mailing Address - Phone:503-803-7713
Mailing Address - Fax:503-285-5362
Practice Address - Street 1:7210 N OATMAN AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-5836
Practice Address - Country:US
Practice Address - Phone:503-803-7713
Practice Address - Fax:503-285-5362
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health