MEDICARE: ALYSSA ERICKSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	PCI #258	CA
2	171M00000X	Case Manager/Care Coordinator
3	101YP2500X	Professional Counselor	3590	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PCI #258	OTHER	CA	BOARD OF BEHAVIORAL SCIENCES

General Provider Information

NPI Number	:	1376732669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA ERICKSON

Provider Business Mailing Address
First Line	:	855 3RD AVE STE 1110
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91911-1350
Country	:	US
Telephone Number	:	619-934-5770
Fax Number	:

Provider Business Practice Location Address
First Line	:	855 3RD AVE STE 1110
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91911-1350
Country	:	US
Telephone Number	:	619-934-5770
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2007
Last Update Date	:	06/04/2025

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Directions to “ ALYSSA ERICKSON ” Practice Location

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