Provider Demographics
NPI:1972300705
Name:KETTERER, SIMRIT DHILLON (LMFT)
Entity type:Individual
Prefix:
First Name:SIMRIT
Middle Name:DHILLON
Last Name:KETTERER
Suffix:
Gender:
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 320421
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-0107
Mailing Address - Country:US
Mailing Address - Phone:650-940-4600
Mailing Address - Fax:650-961-6349
Practice Address - Street 1:3535 TRUMAN AVE
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4559
Practice Address - Country:US
Practice Address - Phone:650-940-4600
Practice Address - Fax:650-961-6349
Is Sole Proprietor?:No
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53802106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist