Provider Demographics
NPI:1295717304
Name:KELLER, GAIL LINDA (LCSW)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:LINDA
Last Name:KELLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 WILLAMETTE ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-3241
Mailing Address - Country:US
Mailing Address - Phone:541-686-8899
Mailing Address - Fax:541-383-8675
Practice Address - Street 1:3003 WILLAMETTE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3241
Practice Address - Country:US
Practice Address - Phone:541-686-8899
Practice Address - Fax:541-383-8675
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1962101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health