Provider Demographics
NPI:1114056850
Name:CHAU, KERREEN (IMF)
Entity type:Individual
Prefix:MS
First Name:KERREEN
Middle Name:
Last Name:CHAU
Suffix:
Gender:F
Credentials:IMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S EL CAMINO REAL STE 106
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-5504
Mailing Address - Country:US
Mailing Address - Phone:949-769-0153
Mailing Address - Fax:
Practice Address - Street 1:101 S EL CAMINO REAL STE 106
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-5504
Practice Address - Country:US
Practice Address - Phone:949-769-0153
Practice Address - Fax:619-378-7973
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT46122106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist