Provider Demographics
NPI:1578575551
Name:ERICKSON, MICHAEL DEAN (LPC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DEAN
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11107 MCCRACKEN CIR STE A
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-4457
Mailing Address - Country:US
Mailing Address - Phone:832-455-5729
Mailing Address - Fax:
Practice Address - Street 1:11107 MCCRACKEN CIR STE A
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-4457
Practice Address - Country:US
Practice Address - Phone:832-455-5729
Practice Address - Fax:281-970-8559
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144436604Medicaid