Provider Demographics
NPI:1336472562
Name:KERSHAW, MICHAEL H (EDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:H
Last Name:KERSHAW
Suffix:
Gender:M
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1990 E LOHMAN AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-3172
Mailing Address - Country:US
Mailing Address - Phone:575-993-5720
Mailing Address - Fax:575-521-9215
Practice Address - Street 1:1990 E LOHMAN AVE
Practice Address - Street 2:STE. 208
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-3172
Practice Address - Country:US
Practice Address - Phone:575-993-5720
Practice Address - Fax:575-521-9215
Is Sole Proprietor?:No
Enumeration Date:2009-09-04
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0139761101YM0800X
103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health