Provider Demographics
NPI:1831647031
Name:FETTES, ERIN (PSYD)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:
Last Name:FETTES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 KIHAPAI ST APT B
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2630
Mailing Address - Country:US
Mailing Address - Phone:906-361-9684
Mailing Address - Fax:
Practice Address - Street 1:156 KIHAPAI ST APT B
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2630
Practice Address - Country:US
Practice Address - Phone:906-361-9684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0004463103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical