Provider Demographics
NPI:1255887790
Name:GISH-STILES, ERIN
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:GISH-STILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4605 BUENA VISTA ROAD STE 600 #714
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-6119
Mailing Address - Country:US
Mailing Address - Phone:661-390-9188
Mailing Address - Fax:
Practice Address - Street 1:4605 BUENA VISTA ROAD STE 600 #714
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-9331
Practice Address - Country:US
Practice Address - Phone:661-390-9188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78423104100000X
CA953201041C0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program