Provider Demographics
NPI:1114052719
Name:KERWOOD, MICHELLE FAURE (MFT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:FAURE
Last Name:KERWOOD
Suffix:
Gender:F
Credentials:MFT
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 50513
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93150-0513
Mailing Address - Country:US
Mailing Address - Phone:805-252-6844
Mailing Address - Fax:
Practice Address - Street 1:1111 GARDEN ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-1459
Practice Address - Country:US
Practice Address - Phone:805-730-7575
Practice Address - Fax:805-730-7503
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 49198106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist