Provider Demographics
NPI:1033322938
Name:NOLASCO, KERRIE LYNN (IMFT)
Entity type:Individual
Prefix:
First Name:KERRIE
Middle Name:LYNN
Last Name:NOLASCO
Suffix:
Gender:F
Credentials:IMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33131 TIVOLI ST
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-4370
Mailing Address - Country:US
Mailing Address - Phone:951-226-5341
Mailing Address - Fax:
Practice Address - Street 1:224 W GRAHAM AVE
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-3740
Practice Address - Country:US
Practice Address - Phone:951-226-5341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator