Provider Demographics
NPI:1598183824
Name:BROTHERS, ERICKA (LP; PSYD)
Entity Type:Individual
Prefix:
First Name:ERICKA
Middle Name:
Last Name:BROTHERS
Suffix:
Gender:F
Credentials:LP; PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7801 N LAMAR BLVD
Mailing Address - Street 2:STE. B169
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-1016
Mailing Address - Country:US
Mailing Address - Phone:512-343-8307
Mailing Address - Fax:512-524-2230
Practice Address - Street 1:7801 N LAMAR BLVD
Practice Address - Street 2:STE. B169
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-1016
Practice Address - Country:US
Practice Address - Phone:512-343-8307
Practice Address - Fax:512-524-2230
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36429103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX334996101Medicaid
TX345505YM6AMedicare PIN