Provider Demographics
NPI:1003901737
Name:MOEHLENPAH, KERRI LILES (MA, MFT)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:LILES
Last Name:MOEHLENPAH
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12975 BROOKPRINTER PL
Mailing Address - Street 2:SUITE 140
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-8894
Mailing Address - Country:US
Mailing Address - Phone:619-253-6266
Mailing Address - Fax:858-486-0108
Practice Address - Street 1:12975 BROOKPRINTER PL
Practice Address - Street 2:SUITE 140
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-8894
Practice Address - Country:US
Practice Address - Phone:619-253-6266
Practice Address - Fax:858-486-0108
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 41949106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist