Provider Demographics
NPI:1558806372
Name:ERIN BYOUS, MFT LICENSED MARRIAGE AND FAMILY THERAPIST
Entity Type:Organization
Organization Name:ERIN BYOUS, MFT LICENSED MARRIAGE AND FAMILY THERAPIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BYOUS
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:707-338-0343
Mailing Address - Street 1:305 HASH CT
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-6117
Mailing Address - Country:US
Mailing Address - Phone:707-769-9980
Mailing Address - Fax:
Practice Address - Street 1:205 KELLER ST STE 202A
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2878
Practice Address - Country:US
Practice Address - Phone:707-338-0343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90706261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health