Provider Demographics
NPI:1457478414
Name:KING, KERRI CHASE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KERRI
Middle Name:CHASE
Last Name:KING
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 WENTZ DR
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-5920
Mailing Address - Country:US
Mailing Address - Phone:408-852-0500
Mailing Address - Fax:
Practice Address - Street 1:1270 NATIVIDAD RD
Practice Address - Street 2:ROOM 200
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3122
Practice Address - Country:US
Practice Address - Phone:831-755-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21499103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical