Provider Demographics
NPI:1710300983
Name:ERNST, GERRI M (LMFT)
Entity Type:Individual
Prefix:
First Name:GERRI
Middle Name:M
Last Name:ERNST
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 S BASCOM AVE
Mailing Address - Street 2:SUITE 216
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-3545
Mailing Address - Country:US
Mailing Address - Phone:408-295-2511
Mailing Address - Fax:
Practice Address - Street 1:1190 S BASCOM AVE
Practice Address - Street 2:SUITE 216
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3545
Practice Address - Country:US
Practice Address - Phone:408-295-2511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC24887106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist