Provider Demographics
NPI:1306451356
Name:LAKS, ERICA MINDY (LMFT)
Entity type:Individual
Prefix:MS
First Name:ERICA
Middle Name:MINDY
Last Name:LAKS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31938 TEMECULA PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-6841
Mailing Address - Country:US
Mailing Address - Phone:858-381-0509
Mailing Address - Fax:
Practice Address - Street 1:35152 BERGAMOT CV
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-6570
Practice Address - Country:US
Practice Address - Phone:858-381-0509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA121491106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty