Provider Demographics
NPI:1801400486
Name:KERR, BROOKE CATHERINE MAE (LMFT 130696)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:CATHERINE MAE
Last Name:KERR
Suffix:
Gender:F
Credentials:LMFT 130696
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1366 CABRILLO PARK DR APT E
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-3125
Mailing Address - Country:US
Mailing Address - Phone:714-824-1763
Mailing Address - Fax:
Practice Address - Street 1:12821 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2711
Practice Address - Country:US
Practice Address - Phone:657-243-0029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA114023106H00000X
CA130696106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist