Provider Demographics
NPI:1649851825
Name:KERT, DANA (MA, AMFT 124596)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:KERT
Suffix:
Gender:F
Credentials:MA, AMFT 124596
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 S HARBOR BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-5820
Mailing Address - Country:US
Mailing Address - Phone:626-643-5378
Mailing Address - Fax:
Practice Address - Street 1:2750 S HARBOR BLVD STE G
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-5820
Practice Address - Country:US
Practice Address - Phone:626-643-5378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300659BP3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD8864690OtherSUBSTANCE ABUSE