Provider Demographics
NPI:1619043833
Name:EHRMANTROUT, NIKKI RENEE (MS QMHP)
Entity Type:Individual
Prefix:MRS
First Name:NIKKI
Middle Name:RENEE
Last Name:EHRMANTROUT
Suffix:
Gender:F
Credentials:MS QMHP
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:RENEE
Other - Last Name:FULKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2101
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:OR
Mailing Address - Zip Code:97438
Mailing Address - Country:US
Mailing Address - Phone:541-726-8819
Mailing Address - Fax:
Practice Address - Street 1:576 OLIVE STREET SUITE 307
Practice Address - Street 2:DIRECTION SERVICE COUNSELING CENTER
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-344-7303
Practice Address - Fax:541-686-6283
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR037759Medicaid