Healthcare Provider Details

I. General information

NPI: 1003128331
Provider Name (Legal Business Name): TONJA ERICKSON L.C.P.C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2010
Last Update Date: 07/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 N 4TH ST
HAMILTON MT
59840-2401
US

IV. Provider business mailing address

PO BOX 692
CORVALLIS MT
59828-0692
US

V. Phone/Fax

Practice location:
  • Phone: 406-369-5268
  • Fax:
Mailing address:
  • Phone: 406-369-5268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1499
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: