Provider Demographics
NPI:1114767183
Name:KYRIAKOS, ERMA (AMFT)
Entity type:Individual
Prefix:
First Name:ERMA
Middle Name:
Last Name:KYRIAKOS
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1136
Mailing Address - Street 2:
Mailing Address - City:BODEGA BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94923-1136
Mailing Address - Country:US
Mailing Address - Phone:321-652-5166
Mailing Address - Fax:
Practice Address - Street 1:7590 ATKINSON RD
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-2601
Practice Address - Country:US
Practice Address - Phone:415-761-3494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA137020106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist