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General NPI Number Information
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NPI Number | 1609311224
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Entity Type | Individual
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Provider Name | AMIRA FORDHAM ERICKSON MA, MED, LMFTA
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Gender | Female
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Dates
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Enumeration Date | 01/05/2017
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Last Update Date | 01/05/2017
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Provider Practice Location Address
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Address Line | 2711 N 21ST ST
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City | TACOMA
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State | WA
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Zip | 98406-7519
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Country | US
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Telephone | 253-343-8056
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Fax |
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Provider Business Mailing Address
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Address Line | 1532 N PROSPECT ST
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City | TACOMA
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State | WA
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Zip | 98406-8108
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Country | US
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Telephone | 253-343-8056
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MG60646451
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License Number State | WA
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