Provider Demographics
NPI:1225678535
Name:ERIN ANTENEN, LICSW PLLC
Entity Type:Organization
Organization Name:ERIN ANTENEN, LICSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:ANN CLOUTHIER
Authorized Official - Last Name:ANTENEN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:360-920-6472
Mailing Address - Street 1:1106 HARRIS AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-7001
Mailing Address - Country:US
Mailing Address - Phone:360-920-6472
Mailing Address - Fax:360-707-7437
Practice Address - Street 1:1106 HARRIS AVE STE 210
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7001
Practice Address - Country:US
Practice Address - Phone:360-920-6472
Practice Address - Fax:360-707-7437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2105843Medicaid