Healthcare Provider Details

I. General information

NPI: 1558806372
Provider Name (Legal Business Name): ERIN BYOUS, MFT LICENSED MARRIAGE AND FAMILY THERAPIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2017
Last Update Date: 01/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 KELLER ST STE 202A
PETALUMA CA
94952-2878
US

IV. Provider business mailing address

305 HASH CT
PETALUMA CA
94952-6117
US

V. Phone/Fax

Practice location:
  • Phone: 707-338-0343
  • Fax:
Mailing address:
  • Phone: 707-769-9980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number90706
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number90706
License Number StateCA

VIII. Authorized Official

Name: ERIN BYOUS
Title or Position: THERAPIST
Credential: MFT
Phone: 707-338-0343