Provider Demographics
NPI:1053041194
Name:ERICKSON, KAYLA ANTHONY (LPC)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:ANTHONY
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 THORNGATE DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-4202
Mailing Address - Country:US
Mailing Address - Phone:601-540-0886
Mailing Address - Fax:
Practice Address - Street 1:102 THORNGATE DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-4202
Practice Address - Country:US
Practice Address - Phone:601-540-0886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-13
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1569101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional