Provider Demographics
NPI:1285810184
Name:ERICKSON, MA, CSP, NCC, LMHC, TOM (LMHC)
Entity type:Individual
Prefix:MR
First Name:TOM
Middle Name:
Last Name:ERICKSON, MA, CSP, NCC, LMHC
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2707
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-2707
Mailing Address - Country:US
Mailing Address - Phone:360-668-2888
Mailing Address - Fax:
Practice Address - Street 1:17610 WOODINVILLE SNOHOMISH RD NE # 2707
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-9818
Practice Address - Country:US
Practice Address - Phone:360-668-2888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2011-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00011320101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health