Provider Demographics
NPI:1841755931
Name:PRIESKORN, ERIN LOUISE (LMFT, LPCC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:LOUISE
Last Name:PRIESKORN
Suffix:
Gender:F
Credentials:LMFT, LPCC
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:LOUISE
Other - Last Name:DOHERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 480
Mailing Address - Street 2:
Mailing Address - City:GUERNEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95446-0480
Mailing Address - Country:US
Mailing Address - Phone:707-565-1370
Mailing Address - Fax:
Practice Address - Street 1:16390 MAIN ST
Practice Address - Street 2:
Practice Address - City:GUERNEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95446-9677
Practice Address - Country:US
Practice Address - Phone:707-565-1370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC14316101YM0800X
CALMFT137457106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health