MEDICARE: ERICKA HADDOCK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1073902110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICKA HADDOCK

Provider Business Mailing Address
First Line	:	6909 FOREST GATE ST # 89084
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-3170
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6909 FOREST GATE ST # 89084
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-3170
Country	:	US
Telephone Number	:	702-994-7107
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2015
Last Update Date	:	01/13/2015

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Directions to “ ERICKA HADDOCK ” Practice Location

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