Healthcare Provider Details

I. General information

NPI: 1528507167
Provider Name (Legal Business Name): ERICA K MAZURKIEWICZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2017
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8923 HIGHWAY 32
SAINTE GENEVIEVE MO
63670
US

IV. Provider business mailing address

10160 FOX HAVEN RD
BLACKWELL MO
63626-9534
US

V. Phone/Fax

Practice location:
  • Phone: 573-854-9978
  • Fax:
Mailing address:
  • Phone: 636-232-7539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2016013361
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: