Provider Demographics
NPI:1114056850
Name:CHAU, KERREEN (IMF)
Entity Type:Individual
Prefix:MS
First Name:KERREEN
Middle Name:
Last Name:CHAU
Suffix:
Gender:F
Credentials:IMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 STEVEMARK LN
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-1728
Mailing Address - Country:US
Mailing Address - Phone:619-990-1433
Mailing Address - Fax:
Practice Address - Street 1:4080 CENTRE ST
Practice Address - Street 2:SUITE101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2655
Practice Address - Country:US
Practice Address - Phone:619-543-9850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF49246101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health