Provider Demographics
NPI:1205937216
Name:KEMMER, IAN MATTHEW (LMFT)
Entity type:Individual
Prefix:MR
First Name:IAN
Middle Name:MATTHEW
Last Name:KEMMER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 E BALL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-5159
Mailing Address - Country:US
Mailing Address - Phone:714-517-6300
Mailing Address - Fax:714-517-6306
Practice Address - Street 1:2035 E BALL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-5159
Practice Address - Country:US
Practice Address - Phone:714-517-6300
Practice Address - Fax:714-517-6306
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT40602106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist