Provider Demographics
NPI:1184197626
Name:ERICKSON, DAYNA NATASHA (FSP)
Entity Type:Individual
Prefix:
First Name:DAYNA
Middle Name:NATASHA
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:FSP
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 250
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:OK
Mailing Address - Zip Code:74743-0250
Mailing Address - Country:US
Mailing Address - Phone:580-326-7531
Mailing Address - Fax:
Practice Address - Street 1:411 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-6059
Practice Address - Country:US
Practice Address - Phone:580-286-5045
Practice Address - Fax:580-286-5721
Is Sole Proprietor?:No
Enumeration Date:2019-01-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OK1184197626175T00000X
OK174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No174H00000XOther Service ProvidersHealth Educator