Provider Demographics
NPI:1760758379
Name:KERR, ANNETTE M (LPC)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:M
Last Name:KERR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5624 SW GREEN OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-1161
Mailing Address - Country:US
Mailing Address - Phone:682-808-3769
Mailing Address - Fax:
Practice Address - Street 1:1807 LAKES EDGE BLVD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-4020
Practice Address - Country:US
Practice Address - Phone:682-808-3769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0140551101YM0800X, 101YP2500X
TX74738101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health