Provider Demographics
NPI:1316460231
Name:TAMMY ERICKSON COUNSELING, LLC
Entity type:Organization
Organization Name:TAMMY ERICKSON COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING/BILLING MANG.
Authorized Official - Prefix:
Authorized Official - First Name:TOMEKA
Authorized Official - Middle Name:C
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MBRS
Authorized Official - Phone:402-885-7672
Mailing Address - Street 1:649 HIGHWAY 92
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:NE
Mailing Address - Zip Code:68864-1121
Mailing Address - Country:US
Mailing Address - Phone:308-383-7950
Mailing Address - Fax:308-795-8847
Practice Address - Street 1:2121 N WEBB RD STE 307
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-1751
Practice Address - Country:US
Practice Address - Phone:308-383-7950
Practice Address - Fax:308-795-2247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-23
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1363101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty