Provider Demographics
NPI:1043414568
Name:CERVANTEZ, ERICA
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:CERVANTEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14
Mailing Address - Street 2:
Mailing Address - City:CAPULIN
Mailing Address - State:CO
Mailing Address - Zip Code:81124-0014
Mailing Address - Country:US
Mailing Address - Phone:719-480-9715
Mailing Address - Fax:
Practice Address - Street 1:8435 COUNTY ROAD Y
Practice Address - Street 2:
Practice Address - City:CAPULIN
Practice Address - State:CO
Practice Address - Zip Code:81124-5035
Practice Address - Country:US
Practice Address - Phone:719-480-9715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LPC003470101YP2500X
COLPC003470101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional