Provider Demographics
NPI:1508874629
Name:KERR, TRISHA BOWEN (LPC, RN, CNS PMH,CEA)
Entity Type:Individual
Prefix:MS
First Name:TRISHA
Middle Name:BOWEN
Last Name:KERR
Suffix:
Gender:F
Credentials:LPC, RN, CNS PMH,CEA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 LULLABYE LN
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-8875
Mailing Address - Country:US
Mailing Address - Phone:936-588-6122
Mailing Address - Fax:936-588-6124
Practice Address - Street 1:14729 HIGHWAY 105 W
Practice Address - Street 2:SUITE 180
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-6025
Practice Address - Country:US
Practice Address - Phone:936-588-6122
Practice Address - Fax:936-588-6124
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12649101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health