Provider Demographics
NPI:1689307720
Name:MACHEN, ERIN (LAC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:MACHEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 NE ALPHA CIR APT 100
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-2039
Mailing Address - Country:US
Mailing Address - Phone:479-308-8244
Mailing Address - Fax:
Practice Address - Street 1:600 NE ALPHA CIR APT 100
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-2039
Practice Address - Country:US
Practice Address - Phone:479-308-8244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2205007101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health