Provider Demographics
NPI:1053193243
Name:KEHOE-ANDERSON, MARIAH MICHELE (CP61414758)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:MICHELE
Last Name:KEHOE-ANDERSON
Suffix:
Gender:F
Credentials:CP61414758
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2713 W MAPLEWOOD AVE APT 111
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-8836
Mailing Address - Country:US
Mailing Address - Phone:360-421-8571
Mailing Address - Fax:
Practice Address - Street 1:2616 KWINA RD
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-9291
Practice Address - Country:US
Practice Address - Phone:360-384-7182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61414758101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)