Provider Demographics
NPI:1548561293
Name:RAFFERTY-BUGHER, ERIN MARIE (ATR-BC, LPCC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:MARIE
Last Name:RAFFERTY-BUGHER
Suffix:
Gender:F
Credentials:ATR-BC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 GRANDVIEW AVE W
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-4518
Mailing Address - Country:US
Mailing Address - Phone:612-205-1687
Mailing Address - Fax:
Practice Address - Street 1:711 W LAKE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2918
Practice Address - Country:US
Practice Address - Phone:612-205-1687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC000222101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional