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General NPI Number Information
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NPI Number | 1164731162
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Entity Type | Individual
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Provider Name | SCOTT VANCE ERICSON LPC, LMFT
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Gender | Male
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Dates
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Enumeration Date | 09/25/2010
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Last Update Date | 09/25/2010
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Provider Practice Location Address
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Address Line | 1814 8TH AVE SUITE A
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City | FORT WORTH
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State | TX
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Zip | 76110-1354
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Country | US
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Telephone | 817-454-1354
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Fax | 817-922-7895
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Provider Business Mailing Address
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Address Line | 1814 8TH AVE SUITE A
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City | FORT WORTH
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State | TX
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Zip | 76110-1354
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Country | US
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Telephone | 817-454-1354
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Fax | 817-922-7895
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 9310
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 716
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License Number State | TX
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