Provider Demographics
NPI:1952689622
Name:CRISHAM, ERIN M (MHS, CRC, LPC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:M
Last Name:CRISHAM
Suffix:
Gender:F
Credentials:MHS, CRC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 918
Mailing Address - Street 2:
Mailing Address - City:LULING
Mailing Address - State:LA
Mailing Address - Zip Code:70070-0918
Mailing Address - Country:US
Mailing Address - Phone:985-414-0786
Mailing Address - Fax:985-308-1053
Practice Address - Street 1:13513 RIVER RD
Practice Address - Street 2:
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070-4259
Practice Address - Country:US
Practice Address - Phone:985-414-0786
Practice Address - Fax:985-308-1053
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3726101YP2500X
LA89652101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional