Provider Demographics
NPI:1093384547
Name:GRANTZ, ERIKA (LMFT-INTERN)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:GRANTZ
Suffix:
Gender:F
Credentials:LMFT-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 SE VIEWMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-1903
Mailing Address - Country:US
Mailing Address - Phone:541-220-0658
Mailing Address - Fax:
Practice Address - Street 1:420 NW 2ND ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6442
Practice Address - Country:US
Practice Address - Phone:541-203-0523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-20
Last Update Date:2021-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist