Provider Demographics
NPI:1306192653
Name:WEHR, KACEY LYNN (MA, IMF)
Entity Type:Individual
Prefix:MRS
First Name:KACEY
Middle Name:LYNN
Last Name:WEHR
Suffix:
Gender:F
Credentials:MA, IMF
Other - Prefix:
Other - First Name:KACEY
Other - Middle Name:LYNN
Other - Last Name:FORREST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 122429
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92112-2429
Mailing Address - Country:US
Mailing Address - Phone:619-702-5571
Mailing Address - Fax:
Practice Address - Street 1:2801 CAMINO DEL RIO S
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3800
Practice Address - Country:US
Practice Address - Phone:619-702-5571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC43476106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist