Provider Demographics
NPI:1588390348
Name:POPP, ERIN BETH (MA, LEP)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:BETH
Last Name:POPP
Suffix:
Gender:F
Credentials:MA, LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31815 CAMINO CAPISTRANO STE 26
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-3254
Mailing Address - Country:US
Mailing Address - Phone:949-422-2789
Mailing Address - Fax:
Practice Address - Street 1:31815 CAMINO CAPISTRANO STE 26
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-3254
Practice Address - Country:US
Practice Address - Phone:949-422-2789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3706103TS0200X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool