| Erickson Psychological Services Llc | |
|
315 S Allen St Suite 421 State College PA 16801-4849 | |
| (814) 466-2133 | |
| Not Available |
| Full Name | Erickson Psychological Services Llc |
|---|---|
| Speciality | Psychologist |
| Location | 315 S Allen St, State College, Pennsylvania |
| Authorized Official Name and Position | John Raymond Erickson (OWNER) |
| Authorized Official Contact | 8144662133 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Erickson Psychological Services Llc 315 S Allen St Suite 421 State College PA 16801-4849 Ph: (814) 466-2133 | Erickson Psychological Services Llc 315 S Allen St Suite 421 State College PA 16801-4849 Ph: (814) 466-2133 |
| NPI Number | 1679963193 |
|---|---|
| Provider Enumeration Date | 02/04/2015 |
| Last Update Date | 02/05/2015 |
| Medicare PECOS PAC ID | 1254659808 |
|---|---|
| Medicare Enrollment ID | O20150413000447 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679963193 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PS007918L (Pennsylvania) | Primary |
| Provider Name | John R Erickson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1366434466 PECOS PAC ID: 7618978180 Enrollment ID: I20070125000443 |
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