Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | LCPC-360 | ID |
N | 101YS0200X | School Counselor | LCPC-360 | ID |
NPI | 1154595759 |
---|---|
Provider Name | Erinn Denise Erickson |
First Address | Boise, ID 83713-1234 |
Second Address | Boise, ID 83712-6420 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2008 |
Last Update Date | 15/04/2008 |