Provider Demographics
NPI:1689382046
Name:CARRUTHERS, KESHAE
Entity Type:Individual
Prefix:
First Name:KESHAE
Middle Name:
Last Name:CARRUTHERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 WILSHIRE BLVD APT 224
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-3033
Mailing Address - Country:US
Mailing Address - Phone:682-554-9682
Mailing Address - Fax:
Practice Address - Street 1:1515 WILSHIRE BLVD APT 224
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-3033
Practice Address - Country:US
Practice Address - Phone:682-554-9682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist