Provider Demographics
NPI:1720429640
Name:ERICKSON-TREMBATH, LIANNA (LCPC, NCC, ACADC)
Entity Type:Individual
Prefix:
First Name:LIANNA
Middle Name:
Last Name:ERICKSON-TREMBATH
Suffix:
Gender:F
Credentials:LCPC, NCC, ACADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5583 N GLENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-1336
Mailing Address - Country:US
Mailing Address - Phone:208-287-2564
Mailing Address - Fax:
Practice Address - Street 1:5583 N GLENWOOD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714-1336
Practice Address - Country:US
Practice Address - Phone:208-287-2564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID5271101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional