Provider Demographics
NPI:1972634434
Name:JEFFREY WHITNEY ERICKSON PHD. P.C.
Entity type:Organization
Organization Name:JEFFREY WHITNEY ERICKSON PHD. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:WHITNEY
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:865-330-0191
Mailing Address - Street 1:5401 KINGSTON PIKE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-5022
Mailing Address - Country:US
Mailing Address - Phone:865-330-0191
Mailing Address - Fax:865-003-3611
Practice Address - Street 1:5401 KINGSTON PIKE
Practice Address - Street 2:SUITE 280
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5022
Practice Address - Country:US
Practice Address - Phone:865-330-0191
Practice Address - Fax:865-003-3611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000000499103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty