Basic Information
| Provider Information | |||||||||
| NPI: | 1215305008 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOUG | ||||||||
| FirstName: | ERIN | ||||||||
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| Credential: | B.C.B.A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 990 GARFIELD WOODS DR | ||||||||
| Address2: | STE B | ||||||||
| City: | TRAVERSE CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49686 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2319431334 | ||||||||
| FaxNumber: | 2319431334 | ||||||||
| Practice Location | |||||||||
| Address1: | 990 GARFIELD WOODS DR | ||||||||
| Address2: | STE B | ||||||||
| City: | TRAVERSE CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49686 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2319431334 | ||||||||
| FaxNumber: | 2319431334 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2015 | ||||||||
| LastUpdateDate: | 09/10/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-14-17384 | CO | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.