Provider Demographics
NPI:1699333617
Name:ERICKSON, COURTNEY (LM, CPM)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 MISTYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-2071
Mailing Address - Country:US
Mailing Address - Phone:972-897-8433
Mailing Address - Fax:
Practice Address - Street 1:1104 MISTYWOOD LN
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-2071
Practice Address - Country:US
Practice Address - Phone:972-897-8433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX176B00000X
374J00000X
TX99459176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula