Provider Demographics
NPI:1730432915
Name:RALSTON, ERIN WALRATH (MA)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:WALRATH
Last Name:RALSTON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:MICHELLE
Other - Last Name:WALRATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1699 S TRENTON ST UNIT 117
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-5604
Mailing Address - Country:US
Mailing Address - Phone:206-550-3342
Mailing Address - Fax:
Practice Address - Street 1:11059 E BETHANY DR STE 200
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80014-2637
Practice Address - Country:US
Practice Address - Phone:206-550-3342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CO101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator