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NPI Code Detail

MEDICARE: MR. ERICK VAN WALDROP LADC/MH COUNSELOR

MEDICARE: MR. ERICK VAN WALDROP LADC/MH COUNSELOR
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1538703798
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ERICK VAN WALDROP LADC/MH COUNSELOR
Provider Business Mailing Address
First Line : 1613 SE 66TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73149-5203
Country : US
Telephone Number : 405-616-3366
Fax Number : 405-616-4925
Provider Business Practice Location Address
First Line : 1613 SE 66TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73149-5203
Country : US
Telephone Number : 405-616-3366
Fax Number : 405-616-4925
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2019
Last Update Date : 10/31/2019

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