Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 1499 | MT |
NPI | 1003128331 |
---|---|
Provider Name | Tonja Erickson |
First Address | Corvallis, MT 59828-0692 |
Second Address | Hamilton, MT 59840-2401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2010 |
Last Update Date | 01/07/2010 |