Healthcare Provider Details

I. General information

NPI: 1104055508
Provider Name (Legal Business Name): SHERI DENHAM KEFFER PH.D MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 05/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 DOVE ST STE 140
NEWPORT BEACH CA
92660-3034
US

IV. Provider business mailing address

739 CALLE BAHIA
SAN CLEMENTE CA
92672-2418
US

V. Phone/Fax

Practice location:
  • Phone: 949-295-6878
  • Fax:
Mailing address:
  • Phone: 949-295-6878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT 44175
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: