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NPI Code Detail

MEDICARE: CAROLYN ERICKSON LPC C

MEDICARE:   CAROLYN  ERICKSON  LPC C
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
1101YM0800XMental Health Counselor0073101NM

General Provider Information

NPI Number : 1477541928
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROLYN ERICKSON LPC C
Provider Business Mailing Address
First Line : 3250 TRINITY DR
Second Line : STE C
City : LOS ALAMOS
State : NM
Zip : 87544-2226
Country : US
Telephone Number : 505-662-1419
Fax Number : 505-661-0055
Provider Business Practice Location Address
First Line : 3250 TRINITY DR
Second Line : STE C
City : LOS ALAMOS
State : NM
Zip : 87544-2226
Country : US
Telephone Number : 505-662-1419
Fax Number : 505-661-0055
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2005
Last Update Date : 07/08/2007

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Directions to “ CAROLYN ERICKSON LPC C” Practice Location

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