Provider Demographics
NPI:1386224178
Name:BADER, ERIN (LMFT, RN)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:
Last Name:BADER
Suffix:
Gender:F
Credentials:LMFT, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4731 E MOSSBERG CIR
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-6206
Mailing Address - Country:US
Mailing Address - Phone:208-981-1459
Mailing Address - Fax:
Practice Address - Street 1:4731 E MOSSBERG CIR
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-6206
Practice Address - Country:US
Practice Address - Phone:208-981-1459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT53618106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALMFT53618OtherDCA