Individual
DR. CARL MICHAEL KERCKHOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
670 N RICK ST, ORANGE, CA 92869-2663
(949) 412-8818
Mailing address
PO BOX 12371, ORANGE, CA 92859-8371
(949) 412-8818
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY 17976
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PSY17976
PSYCHOLOGIST LICENSE
CA
Enumeration date
10/17/2006
Last updated
03/20/2019
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