Provider Demographics
NPI:1215217500
Name:AVALOS, ERICALYNN SHIFTER (MS)
Entity type:Individual
Prefix:MRS
First Name:ERICALYNN
Middle Name:SHIFTER
Last Name:AVALOS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-8014
Mailing Address - Country:US
Mailing Address - Phone:909-748-0259
Mailing Address - Fax:909-748-6451
Practice Address - Street 1:1812 W PARK AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-8014
Practice Address - Country:US
Practice Address - Phone:909-748-0259
Practice Address - Fax:909-748-6451
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90320106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist