Healthcare Provider Details

I. General information

NPI: 1912937749
Provider Name (Legal Business Name): CAROL J. ERICKSON, PSYD., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 W 19TH ST STE 6
CHEYENNE WY
82001-4307
US

IV. Provider business mailing address

620 W 19TH ST STE 6
CHEYENNE WY
82001-4307
US

V. Phone/Fax

Practice location:
  • Phone: 307-637-5808
  • Fax: 307-432-6775
Mailing address:
  • Phone: 307-637-5808
  • Fax: 307-432-6775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number303
License Number StateWY

VIII. Authorized Official

Name: DR. CAROL J ERICKSON
Title or Position: LICENSED PSYCHOLOGIST
Credential: PSY.D.
Phone: 307-637-5808