Provider Demographics
NPI: | 1649421587 |
---|---|
Name: | ERH INC |
Entity Type: | Organization |
Organization Name: | ERH INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PSYCHOLOGIST |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | TROY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | FENLASON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PSYD |
Authorized Official - Phone: | 425-275-2637 |
Mailing Address - Street 1: | PO BOX 60261 |
Mailing Address - Street 2: | |
Mailing Address - City: | SEATTLE |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 98160-0261 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 425-275-2637 |
Mailing Address - Fax: | 206-363-9639 |
Practice Address - Street 1: | 2611 NE 125TH ST |
Practice Address - Street 2: | SUITE 111 |
Practice Address - City: | SEATTLE |
Practice Address - State: | WA |
Practice Address - Zip Code: | 98125-4373 |
Practice Address - Country: | US |
Practice Address - Phone: | 425-275-2637 |
Practice Address - Fax: | 206-299-2289 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-10-09 |
Last Update Date: | 2011-11-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WA | PY60090118 | 103TC0700X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Single Specialty |