Provider Demographics
NPI:1447016225
Name:ERICKSON, TAYLORE PAIGE
Entity type:Individual
Prefix:
First Name:TAYLORE
Middle Name:PAIGE
Last Name:ERICKSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 E THOMAS AVE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075-2600
Mailing Address - Country:US
Mailing Address - Phone:405-372-7791
Mailing Address - Fax:
Practice Address - Street 1:421 E THOMAS AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075-2600
Practice Address - Country:US
Practice Address - Phone:405-372-7791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-28
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health