Healthcare Provider Details

I. General information

NPI: 1962127092
Provider Name (Legal Business Name): KARA ERICKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 NIKLES DR STE 3B
BOZEMAN MT
59715-2570
US

IV. Provider business mailing address

601 NIKLES DR STE 3
BOZEMAN MT
59715-2570
US

V. Phone/Fax

Practice location:
  • Phone: 406-521-7657
  • Fax:
Mailing address:
  • Phone: 808-990-4636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: