Provider Demographics
NPI:1154976496
Name:BRESSETTE, KERI A (PHD)
Entity type:Individual
Prefix:
First Name:KERI
Middle Name:A
Last Name:BRESSETTE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 BOB WALLACE AVE SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3810
Mailing Address - Country:US
Mailing Address - Phone:256-642-7400
Mailing Address - Fax:256-642-7600
Practice Address - Street 1:201 BOB WALLACE AVE SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3810
Practice Address - Country:US
Practice Address - Phone:256-642-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2195103TC0700X
GA004304103TC0700X
GAPSY004304103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical