Provider Demographics
NPI:1013599596
Name:DEETER, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:DEETER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 MARTIN LUTHER KING JR WAY
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-6107
Mailing Address - Country:US
Mailing Address - Phone:815-272-0444
Mailing Address - Fax:
Practice Address - Street 1:107 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-6107
Practice Address - Country:US
Practice Address - Phone:815-272-0444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-24
Last Update Date:2021-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health