Provider Demographics
NPI:1548089394
Name:BENNETT, ERIN (MC61500734)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MC61500734
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13215 SE MILL PLAIN BLVD
Mailing Address - Street 2:STE C8, #2002
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684
Mailing Address - Country:US
Mailing Address - Phone:360-287-4420
Mailing Address - Fax:
Practice Address - Street 1:7708 NE 78TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-3603
Practice Address - Country:US
Practice Address - Phone:360-287-4429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61500734101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health