Provider Demographics
NPI:1912937749
Name:CAROL J. ERICKSON, PSYD., P.C.
Entity Type:Organization
Organization Name:CAROL J. ERICKSON, PSYD., P.C.
Other - Org Name:CE MENTAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:307-637-5808
Mailing Address - Street 1:620 W 19TH ST
Mailing Address - Street 2:STE 6
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-4307
Mailing Address - Country:US
Mailing Address - Phone:307-637-5808
Mailing Address - Fax:307-432-6775
Practice Address - Street 1:620 W 19TH ST
Practice Address - Street 2:STE 6
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4307
Practice Address - Country:US
Practice Address - Phone:307-637-5808
Practice Address - Fax:307-432-6775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY303103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
310907OtherBC/BS
WY310907Medicare UPIN