Provider Demographics
NPI:1497814586
Name:MATTERS, ERICA DAWN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:DAWN
Last Name:MATTERS
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 1:207 BROADMOOR DR
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-9298
Mailing Address - Country:US
Mailing Address - Phone:816-322-0606
Mailing Address - Fax:
Practice Address - Street 1:207 BROADMOOR DR
Practice Address - Street 2:
Practice Address - City:RAYMORE
Practice Address - State:MO
Practice Address - Zip Code:64083-9298
Practice Address - Country:US
Practice Address - Phone:816-377-0108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004003788101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional