Provider Demographics
NPI:1518005172
Name:TEA, ERYS KATHERINE (LCSW)
Entity type:Individual
Prefix:MS
First Name:ERYS
Middle Name:KATHERINE
Last Name:TEA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ERYS
Other - Middle Name:KATE
Other - Last Name:TEA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:P.O. BOX 288
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611
Mailing Address - Country:US
Mailing Address - Phone:907-283-6551
Mailing Address - Fax:907-283-6553
Practice Address - Street 1:215 FIDALGO AVENUE
Practice Address - Street 2:SUITE 204 C
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611
Practice Address - Country:US
Practice Address - Phone:907-283-6551
Practice Address - Fax:907-283-6553
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical