Provider Demographics
NPI:1730405697
Name:BACHER, ERICA DAWN
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:DAWN
Last Name:BACHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:DAWN
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14019 S WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:OOLOGAH
Mailing Address - State:OK
Mailing Address - Zip Code:74053-3982
Mailing Address - Country:US
Mailing Address - Phone:808-392-7972
Mailing Address - Fax:
Practice Address - Street 1:14019 S WILLOW DR
Practice Address - Street 2:
Practice Address - City:OOLOGAH
Practice Address - State:OK
Practice Address - Zip Code:74053-3982
Practice Address - Country:US
Practice Address - Phone:808-392-7972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 373H00000X
OK437629103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist