Provider Demographics
NPI:1306333133
Name:KETTERLING, ALAN P (MA, LMFT)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:P
Last Name:KETTERLING
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18450 W BROOKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-6476
Mailing Address - Country:US
Mailing Address - Phone:623-377-4737
Mailing Address - Fax:
Practice Address - Street 1:5902 W CACTUS RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-1710
Practice Address - Country:US
Practice Address - Phone:623-377-4737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15683106H00000X
AZLAMFT-10584106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist