Provider Demographics
NPI:1568883023
Name:BOSOLD, ERIKA (LPC)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:BOSOLD
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 1:1409 S GREENWICH AVE
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-6992
Mailing Address - Country:US
Mailing Address - Phone:870-878-2294
Mailing Address - Fax:
Practice Address - Street 1:910 S ROGERS ST STE G
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-4331
Practice Address - Country:US
Practice Address - Phone:479-335-5747
Practice Address - Fax:479-957-9083
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-30
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 101YP2500X
ARA1912186101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health