Provider Demographics
NPI:1982048518
Name:FACKLER, ERIN RUBY
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:RUBY
Last Name:FACKLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10116 36TH AVENUE CT SW
Mailing Address - Street 2:SUITE 109
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-4791
Mailing Address - Country:US
Mailing Address - Phone:800-991-6070
Mailing Address - Fax:800-991-6071
Practice Address - Street 1:10116 36TH AVENUE CT SW
Practice Address - Street 2:SUITE 109
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-4791
Practice Address - Country:US
Practice Address - Phone:800-991-6070
Practice Address - Fax:800-991-6071
Is Sole Proprietor?:No
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor