Provider Demographics
NPI:1558729939
Name:HUERTAS, ERICA (LMHC)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:HUERTAS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5835 MEMORIAL HWY
Mailing Address - Street 2:SUITE 19
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-5005
Mailing Address - Country:US
Mailing Address - Phone:813-586-1414
Mailing Address - Fax:813-862-9995
Practice Address - Street 1:5835 MEMORIAL HWY
Practice Address - Street 2:SUITE 19
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-5005
Practice Address - Country:US
Practice Address - Phone:813-586-1414
Practice Address - Fax:813-862-9995
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-01
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13967101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016718100Medicaid