Keith Vidra

NPI #1861989865 in Ukiah, California

Provider Information

NPI Number: 1861989865
Entity Type: Individual
Name: Keith Vidra
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Counselor
Enumeration Date: Apr 16, 2018
Last Updated: Apr 16, 2018

Practice Location

Address: 140 GIBSON ST
City: Ukiah
State: California
ZIP Code: 95482-3941
Phone: (707) 468-5536

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor	101Y00000X	Primary

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