Provider Demographics
NPI:1083069181
Name:BOOKER, ERIN (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:
Last Name:BOOKER
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E KENNEDY ST
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:IL
Mailing Address - Zip Code:61951-1646
Mailing Address - Country:US
Mailing Address - Phone:217-259-9680
Mailing Address - Fax:
Practice Address - Street 1:120 E KENNEDY ST
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:IL
Practice Address - Zip Code:61951-1646
Practice Address - Country:US
Practice Address - Phone:217-259-9680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.011985101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional