Provider Demographics
NPI:1952886962
Name:VIVYAN, ERIKA JANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ERIKA
Middle Name:JANE
Last Name:VIVYAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 WILD BASIN #3 SUITE 202
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TN
Mailing Address - Zip Code:78746
Mailing Address - Country:US
Mailing Address - Phone:512-246-7225
Mailing Address - Fax:
Practice Address - Street 1:205 WILD BASIN #3 SUITE 202
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746
Practice Address - Country:US
Practice Address - Phone:512-246-7225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37950103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist