Provider Demographics
NPI:1679358733
Name:DAM-ERICKSON, SHAY E (MA, LPC)
Entity Type:Individual
Prefix:
First Name:SHAY
Middle Name:E
Last Name:DAM-ERICKSON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:SHAY
Other - Middle Name:
Other - Last Name:ERICKSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:10900 RESEARCH BLVD STE 160C
Mailing Address - Street 2:PMB 1510
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5718
Mailing Address - Country:US
Mailing Address - Phone:512-264-4942
Mailing Address - Fax:
Practice Address - Street 1:4703 GONZALES STREET
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702
Practice Address - Country:US
Practice Address - Phone:512-264-4942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67966101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional