Healthcare Provider Details

I. General information

NPI: 1932239159
Provider Name (Legal Business Name): KERISHA NICHELE EARLES M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 04/25/2022
Certification Date: 04/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 N ORANGE GROVE BLVD
PASADENA CA
91103-3333
US

IV. Provider business mailing address

12734 CYPRESS KNOLL LN
HAWTHORNE CA
90250-3382
US

V. Phone/Fax

Practice location:
  • Phone: 626-796-3453
  • Fax:
Mailing address:
  • Phone: 323-707-3981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number132034
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: