Provider Demographics
NPI:1174982300
Name:ASK, KEITH
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:
Last Name:ASK
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 1:425 NW LOST SPRINGS TER
Mailing Address - Street 2:UNIT #302
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-6454
Mailing Address - Country:US
Mailing Address - Phone:503-239-5738
Mailing Address - Fax:
Practice Address - Street 1:2600 SE BELMONT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2916
Practice Address - Country:US
Practice Address - Phone:503-239-5738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)