Provider Demographics
NPI:1043710338
Name:JARRETT, ERIN DAWN (MFTA, LSGC, TCADC)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:DAWN
Last Name:JARRETT
Suffix:
Gender:F
Credentials:MFTA, LSGC, TCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1939 GOLDSMITH LN STE 147
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-3047
Mailing Address - Country:US
Mailing Address - Phone:502-821-0091
Mailing Address - Fax:
Practice Address - Street 1:1939 GOLDSMITH LN STE 147
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-3047
Practice Address - Country:US
Practice Address - Phone:502-821-0091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY172920101YA0400X
KY201195131101YS0200X
KY175245106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool