Provider Demographics
NPI:1053733949
Name:BOORMAN, ERIN
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:BOORMAN
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 1:2021 STONE CANYON DR
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-6113
Mailing Address - Country:US
Mailing Address - Phone:435-628-1095
Mailing Address - Fax:
Practice Address - Street 1:1240 E 100 S STE 121
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-3079
Practice Address - Country:US
Practice Address - Phone:435-652-1202
Practice Address - Fax:435-652-1206
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8894810-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health