MEDICARE: ERIN ELIZABETH EKSTROM LPC

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	67556	TX

General Provider Information

NPI Number	:	1699010934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN ELIZABETH EKSTROM LPC

Provider Business Mailing Address
First Line	:	1716 SANDMAN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-2296
Country	:	US
Telephone Number	:	979-637-0556
Fax Number	:

Provider Business Practice Location Address
First Line	:	1716 SANDMAN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-2296
Country	:	US
Telephone Number	:	979-637-0556
Fax Number	:

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

Provider Enumeration Date	:	11/27/2012
Last Update Date	:	11/27/2012

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