Provider Demographics
NPI:1285951939
Name:EMERSON, ERIC OLIVER (MA ED LISAC)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:OLIVER
Last Name:EMERSON
Suffix:
Gender:M
Credentials:MA ED LISAC
Other - Prefix:
Other - First Name:ERIC
Other - Middle Name:O
Other - Last Name:EMERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MAEDLISAC
Mailing Address - Street 1:6000 S BLUCHER DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85746-3302
Mailing Address - Country:US
Mailing Address - Phone:520-419-3639
Mailing Address - Fax:866-824-9980
Practice Address - Street 1:6000 S BLUCHER DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85746-3302
Practice Address - Country:US
Practice Address - Phone:520-419-3639
Practice Address - Fax:866-824-9980
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101Y00000X, 101YM0800X, 101YS0200X
AZLISAC-1242101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool