Healthcare Provider Details

I. General information

NPI: 1386193316
Provider Name (Legal Business Name): JODI MARIE ERICKSON LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JODI MARIE MATHES

II. Dates (important events)

Enumeration Date: 10/03/2016
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W HAWTHORNE ST
FALLBROOK CA
92028-2053
US

IV. Provider business mailing address

150 VALPREDA RD
SAN MARCOS CA
92069-2973
US

V. Phone/Fax

Practice location:
  • Phone: 760-736-6767
  • Fax:
Mailing address:
  • Phone: 760-736-6767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number95595
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: