Provider Demographics
NPI:1073706966
Name:KERHULAS, IKE
Entity type:Individual
Prefix:DR
First Name:IKE
Middle Name:
Last Name:KERHULAS
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:IKE
Other - Middle Name:
Other - Last Name:KERHULAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD MFT
Mailing Address - Street 1:22 VIA DIVERTIRSE
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-7014
Mailing Address - Country:US
Mailing Address - Phone:949-498-3297
Mailing Address - Fax:949-498-3297
Practice Address - Street 1:5425 SIERRA VISTA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3113
Practice Address - Country:US
Practice Address - Phone:951-299-7645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 20162106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist