Provider Demographics
NPI:1699912337
Name:LOMMASSON, ERIC JAMES (LPC)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:JAMES
Last Name:LOMMASSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 W BOLIVAR AVE
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-9134
Mailing Address - Country:US
Mailing Address - Phone:208-964-1729
Mailing Address - Fax:208-665-2016
Practice Address - Street 1:1200 W IRONWOOD DR
Practice Address - Street 2:SUITE 101
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2660
Practice Address - Country:US
Practice Address - Phone:208-664-9729
Practice Address - Fax:208-665-5735
Is Sole Proprietor?:No
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-4174101YP2500X
ID103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool