Provider Demographics
NPI:1679002786
Name:ERIN DURST PSYCHOTHERAPY LLC
Entity Type:Organization
Organization Name:ERIN DURST PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INDIVIDUAL AND FAMILY THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:DURST
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:971-219-7685
Mailing Address - Street 1:1112 NE 21ST AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2595
Mailing Address - Country:US
Mailing Address - Phone:971-219-7685
Mailing Address - Fax:
Practice Address - Street 1:1112 NE 21ST AVE STE 1
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2595
Practice Address - Country:US
Practice Address - Phone:971-219-7685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL6314261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)