Provider Demographics
NPI:1073760534
Name:ERICKSON, SCOTT MARTIN (MCOUN,LPC 1010)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:MARTIN
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:MCOUN,LPC 1010
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 ONYX ST
Mailing Address - Street 2:
Mailing Address - City:KEMMERER
Mailing Address - State:WY
Mailing Address - Zip Code:83101-3214
Mailing Address - Country:US
Mailing Address - Phone:307-877-4496
Mailing Address - Fax:307-877-9769
Practice Address - Street 1:711 ONYX ST
Practice Address - Street 2:
Practice Address - City:KEMMERER
Practice Address - State:WY
Practice Address - Zip Code:83101-3214
Practice Address - Country:US
Practice Address - Phone:307-877-4496
Practice Address - Fax:307-877-9769
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYM.COUN.,L.P.C. 1010101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional