Provider Demographics
NPI:1609311224
Name:FORDHAM ERICKSON, AMIRA (MA, MED, LMFTA)
Entity Type:Individual
Prefix:
First Name:AMIRA
Middle Name:
Last Name:FORDHAM ERICKSON
Suffix:
Gender:F
Credentials:MA, MED, LMFTA
Other - Prefix:
Other - First Name:AMIRA
Other - Middle Name:
Other - Last Name:SIEGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1532 N PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-8108
Mailing Address - Country:US
Mailing Address - Phone:253-343-8056
Mailing Address - Fax:
Practice Address - Street 1:2711 N 21ST ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-7519
Practice Address - Country:US
Practice Address - Phone:253-343-8056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60646451106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist