Provider Demographics
NPI:1952771578
Name:KEBRE, DUSTIN ROSS (MA; LMFT)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:ROSS
Last Name:KEBRE
Suffix:
Gender:M
Credentials:MA; LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17723 TIFFANY TRACE DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-1225
Mailing Address - Country:US
Mailing Address - Phone:310-594-9974
Mailing Address - Fax:
Practice Address - Street 1:7940 N FEDERAL HWY
Practice Address - Street 2:SUITE 120
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-1679
Practice Address - Country:US
Practice Address - Phone:310-594-9974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3057106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist