Individual
THERESA KEYS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRM, PWS
Contact information
Practice address
1741 NEWMARK AVE, COOS BAY, OR 97420-4704
(541) 622-0066
Mailing address
155 S EMPIRE BLVD, COOS BAY, OR 97420-3374
(541) 622-0066
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
21-CRM-705
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
THW000106053
PEER SUPPORT SPECIALIST ADULT ADDICTIONS
OR
Enumeration date
09/12/2022
Last updated
09/12/2022
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