Provider Demographics
NPI:1558552125
Name:KELEMER, SHIRL (MFT 7508)
Entity Type:Individual
Prefix:
First Name:SHIRL
Middle Name:
Last Name:KELEMER
Suffix:
Gender:F
Credentials:MFT 7508
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:749 N HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-6801
Mailing Address - Country:US
Mailing Address - Phone:323-651-4555
Mailing Address - Fax:323-651-5559
Practice Address - Street 1:749 N HARPER AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-6801
Practice Address - Country:US
Practice Address - Phone:323-651-4555
Practice Address - Fax:323-651-5559
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 7508101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA492307OtherVALUE OPTIONS