Basic Information
| Provider Information | |||||||||
| NPI: | 1043737620 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANNING | ||||||||
| FirstName: | ERIN | ||||||||
| MiddleName: | ELAINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 216 CONTRA COSTA AVE | ||||||||
| Address2: | |||||||||
| City: | FIRCREST | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984667226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532294707 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3560 BRIDGEPORT WAY W STE 2C | ||||||||
| Address2: | |||||||||
| City: | UNIVERSITY PLACE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984664446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534607248 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2017 | ||||||||
| LastUpdateDate: | 08/31/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MG.60976878 | WA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.