Provider Demographics
NPI:1417266990
Name:KERRUISH, DANIEL (LMFT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:KERRUISH
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 439
Mailing Address - Street 2:
Mailing Address - City:MENDOCINO
Mailing Address - State:CA
Mailing Address - Zip Code:95460-0439
Mailing Address - Country:US
Mailing Address - Phone:707-357-2372
Mailing Address - Fax:
Practice Address - Street 1:45121 UKIAH ST.
Practice Address - Street 2:NORTH EAST SUITE - SECOND FLOOR
Practice Address - City:MENDOCINO
Practice Address - State:CA
Practice Address - Zip Code:95460
Practice Address - Country:US
Practice Address - Phone:707-357-2372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT 87959106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist