Hendrix, Keith Jacob
Hendrix, Keith Jacob is an sole proprietor health care provider with primary practice located at 45 Nw Greeley Ave , Bend OR 97703-2943. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Counselor, Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Professional is his primary health care specialty. Hendrix, Keith Jacob can be contacted via phone (503) 616-1236.Contact Information
Primary practice address
45 Nw Greeley Ave
Bend OR 97703-2943
Phone: (503) 616-1236
Fax: (855) 305-5252
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Behavioral Health & Social Service Providers / Counselor | 101Y00000X | C1799 | Oregon |
Behavioral Health & Social Service Providers / Professional | 101YP2500X | C1799 | Oregon |
Profile Details
NPI number | 1861662751 |
---|---|
LBN Legal business name | Hendrix, Keith Jacob |
Credentials | Licensed Professional Counselor (LPC) |
Entity | Individual |
Sole proprietor 1 | Yes |
Enumeration date | Mar 6th, 2008 |
Last updated | Nov 10th, 2020 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1861662751 | NPPES |
Oregon | MEDICAID | 123190 |
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