Provider Demographics
NPI:1366868069
Name:HEADLEY, ERIN (LPC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:HEADLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 SW TAYLOR ST STE 345
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2508
Mailing Address - Country:US
Mailing Address - Phone:503-568-1623
Mailing Address - Fax:
Practice Address - Street 1:1020 SW TAYLOR ST STE 345
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2508
Practice Address - Country:US
Practice Address - Phone:503-568-1623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-05
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3252101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional