=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790937001
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIN ELIZABETH MINOR CAP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2008
-----------------------------------------------------
Last Update Date | 10/17/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 209 N LIME AVE
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34237-6123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-228-4310
-----------------------------------------------------
Fax | 941-954-2349
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14167 CATTLE EGRET PL
-----------------------------------------------------
City | LAKEWOOD RANCH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34202-8259
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-228-4310
-----------------------------------------------------
Fax | 941-954-2349
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 4322
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 4322
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------