Provider Demographics
NPI:1205001336
Name:KERKER, MARILYN GAY (MFT)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:GAY
Last Name:KERKER
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 1:65-1158 MAMALAHOA HWY
Mailing Address - Street 2:SUITE 8A, PMB #141
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743
Mailing Address - Country:US
Mailing Address - Phone:808-895-0747
Mailing Address - Fax:
Practice Address - Street 1:234 WAIANUENUE AVENUE
Practice Address - Street 2:SUITE 107
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720
Practice Address - Country:US
Practice Address - Phone:808-895-0747
Practice Address - Fax:808-961-2073
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMFT - 80106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist