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General NPI Number Information
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NPI Number | 1588111280
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Entity Type | Organization
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Legal Business Name | ERICKSON COUNSELING & MEDIATION PLLC
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Dates
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Enumeration Date | 09/09/2016
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Last Update Date | 06/10/2021
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Provider Practice Location Address
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Address Line | 11107 MCCRACKEN CIR STE A
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City | CYPRESS
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State | TX
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Zip | 77429-4457
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Country | US
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Telephone | 832-455-5729
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Fax | 281-970-8559
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Provider Business Mailing Address
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Address Line | 11107 MCCRACKEN CIR STE A
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City | CYPRESS
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State | TX
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Zip | 77429-4457
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Country | US
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Telephone | 832-455-5729
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Fax | 281-970-8559
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Authorized Official
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Title or Position | OWNER
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Name | MR. MICHAEL DEAN ERICKSON
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Credential | LPC
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Telephone | 832-455-5729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 17125
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License Number State | TX
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