Provider Demographics
NPI:1477710580
Name:WOLFF, ERIN JEAN (LMFT)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:JEAN
Last Name:WOLFF
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:JEAN
Other - Last Name:KITUMBA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:P.O. BOX 71093
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97475-0182
Mailing Address - Country:US
Mailing Address - Phone:541-357-8864
Mailing Address - Fax:541-225-5935
Practice Address - Street 1:1126 GATEWAY LOOP
Practice Address - Street 2:SUITE 110
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-7723
Practice Address - Country:US
Practice Address - Phone:541-357-8864
Practice Address - Fax:541-225-5935
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-18
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORT1112106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500660855Medicaid