Healthcare Provider Details

I. General information

NPI: 1083265268
Provider Name (Legal Business Name): ERICKSON THERAPY AND SCHOOL PSYCHOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2019
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 S 800 E
OREM UT
84097-7230
US

IV. Provider business mailing address

1175 S 800 E
OREM UT
84097-7230
US

V. Phone/Fax

Practice location:
  • Phone: 801-836-1846
  • Fax: 801-704-5066
Mailing address:
  • Phone: 801-704-5066
  • Fax: 801-704-5065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. MARTIN J ERICKSON
Title or Position: OWNER
Credential: PHD, LMFT
Phone: 801-752-0266