Basic Information
| Provider Information | |||||||||
| NPI: | 1336615111 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STOCKHAUSEN | ||||||||
| FirstName: | ERIN | ||||||||
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| Credential: | LMHC-A, CN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3116 RACINE ST APT 234 | ||||||||
| Address2: | |||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982266677 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3645 E MCLEOD RD | ||||||||
| Address2: | |||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982268700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606762220 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2018 | ||||||||
| LastUpdateDate: | 10/18/2018 | ||||||||
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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 | 133N00000X | NU60899764 | WA | N | Dietary & Nutritional Service Providers | Nutritionist | 101YM0800X | MC60899421 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.