Provider Demographics
NPI:1326190414
Name:KESHNER, DARELLEA (MA LMFT LEP)
Entity Type:Individual
Prefix:MRS
First Name:DARELLEA
Middle Name:
Last Name:KESHNER
Suffix:
Gender:F
Credentials:MA LMFT LEP
Other - Prefix:
Other - First Name:DEE
Other - Middle Name:
Other - Last Name:CORBEH KESHNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA LMFT LEP
Mailing Address - Street 1:16591 CHARLES OTTER DR
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370
Mailing Address - Country:US
Mailing Address - Phone:204-586-9572
Mailing Address - Fax:
Practice Address - Street 1:101 S FOREST RD
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370
Practice Address - Country:US
Practice Address - Phone:209-499-4079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALEP 1149103T00000X
CAMFC 19973106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist