Provider Demographics
NPI:1235564121
Name:PHERSON, ERICA DIANE (LMHC)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:DIANE
Last Name:PHERSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:DIANE
Other - Last Name:EDLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:334 LONGWOOD ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-6003
Mailing Address - Country:US
Mailing Address - Phone:317-752-3837
Mailing Address - Fax:
Practice Address - Street 1:11950 FISHERS CROSSING DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2702
Practice Address - Country:US
Practice Address - Phone:317-595-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002374A101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional