Individual
KEITH JOHN MACKIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC, CADCI
Contact information
Practice address
1134 NE 70TH AVE, PORTLAND, OR 97213-5420
(971) 207-5010
Mailing address
1134 NE 70TH AVE, PORTLAND, OR 97213-5420
(971) 207-5010
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
07-09-29
OR
101YP2500X
Professional Counselor
Primary
C2348
OR
103TC1900X
Counseling Psychologist
C2348
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164936
—
OR
Enumeration date
09/30/2009
Last updated
02/08/2022
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