Individual
MACKENSIE MARIE KEINER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, CSWA, QMHP
Contact information
Practice address
12725 SW MILLIKAN WAY STE 300, BEAVERTON, OR 97005-1687
(503) 713-5040
(503) 713-5050
Mailing address
605 NW 118TH AVE UNIT 106, PORTLAND, OR 97229-6670
(503) 816-9211
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
A4749
OR
101YM0800X
Mental Health Counselor
A4749
OR
1041C0700X
Clinical Social Worker
Primary
A4749
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500732074
—
OR
Enumeration date
09/19/2017
Last updated
08/26/2020
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