Healthcare Provider Details

I. General information

NPI: 1982716189
Provider Name (Legal Business Name): ERICK R. LENERT PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 12/27/2019
Certification Date: 12/27/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 E SOUTHEAST LOOP 323 STE. 204
TYLER TX
75701-9660
US

IV. Provider business mailing address

1121 E SOUTHEAST LOOP 323 STE. 204
TYLER TX
75701-9660
US

V. Phone/Fax

Practice location:
  • Phone: 903-581-0933
  • Fax: 903-581-3977
Mailing address:
  • Phone: 903-581-0933
  • Fax: 903-581-3977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number23170
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: