Healthcare Provider Details

I. General information

NPI: 1720453582
Provider Name (Legal Business Name): ERIN LYNN SWEET-BRAZEL LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2015
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 N ELM ST
CANBY OR
97013-3519
US

IV. Provider business mailing address

113 N ELM ST
CANBY OR
97013-3519
US

V. Phone/Fax

Practice location:
  • Phone: 503-372-5147
  • Fax: 541-770-9212
Mailing address:
  • Phone: 503-263-8903
  • Fax: 503-266-8632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC5440
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT1698
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: