Provider Demographics
NPI:1780841791
Name:MARTIN, ERIN MARY (LPC, MFT)
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:MARY
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPC, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11780 CENTRAL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-6499
Mailing Address - Country:US
Mailing Address - Phone:909-517-2020
Mailing Address - Fax:099-517-2022
Practice Address - Street 1:11780 CENTRAL AVE STE 100
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-6499
Practice Address - Country:US
Practice Address - Phone:909-517-2020
Practice Address - Fax:909-517-2022
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40349106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA40349OtherLMFT LICENSE