Provider Demographics
NPI:1225419138
Name:DEITERS, ERIK PAUL ANTON (LMFT)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:PAUL ANTON
Last Name:DEITERS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 SHRADER ST APT 6
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-2745
Mailing Address - Country:US
Mailing Address - Phone:415-933-1901
Mailing Address - Fax:
Practice Address - Street 1:2275 MARKET ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-1662
Practice Address - Country:US
Practice Address - Phone:415-508-4037
Practice Address - Fax:415-864-1004
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YA0400X
CAAPCC3700101YP2500X
CAIMF98516106H00000X
CALMFT123439106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)