Provider Demographics
NPI:1578736880
Name:GORES, ERICA (LAMFT)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:GORES
Suffix:
Gender:F
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4655 NICOLS RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-3425
Mailing Address - Country:US
Mailing Address - Phone:952-936-2800
Mailing Address - Fax:
Practice Address - Street 1:4655 NICOLS RD
Practice Address - Street 2:SUITE 206
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-3425
Practice Address - Country:US
Practice Address - Phone:952-936-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1707106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist