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General NPI Number Information
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NPI Number | 1518005172
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Entity Type | Individual
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Provider Name | ERYS KATHERINE TEA LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 01/02/2013
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Provider Practice Location Address
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Address Line | 215 FIDALGO AVENUE SUITE 204 C
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City | KENAI
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State | AK
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Zip | 99611
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Country | US
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Telephone | 907-283-6551
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Fax | 907-283-6553
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Provider Business Mailing Address
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Address Line | P.O. BOX 288
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City | KENAI
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State | AK
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Zip | 99611
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Country | US
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Telephone | 907-283-6551
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Fax | 907-283-6553
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 196
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License Number State | AK
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