Provider Demographics
NPI:1982881538
Name:BLAIR, KERE ANNE (MA, MFTI)
Entity Type:Individual
Prefix:
First Name:KERE
Middle Name:ANNE
Last Name:BLAIR
Suffix:
Gender:F
Credentials:MA, MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13916 CERISE AVE
Mailing Address - Street 2:APT. 29
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-8153
Mailing Address - Country:US
Mailing Address - Phone:562-335-4671
Mailing Address - Fax:
Practice Address - Street 1:525 N PARKER ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-1323
Practice Address - Country:US
Practice Address - Phone:714-639-5547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF79022106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00Other0