Provider Demographics
NPI:1982716189
Name:LENERT, ERICK R (PHD)
Entity Type:Individual
Prefix:
First Name:ERICK
Middle Name:R
Last Name:LENERT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 E SOUTHEAST LOOP 323
Mailing Address - Street 2:STE. 204
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-9660
Mailing Address - Country:US
Mailing Address - Phone:903-581-0933
Mailing Address - Fax:903-581-3977
Practice Address - Street 1:1121 E SOUTHEAST LOOP 323
Practice Address - Street 2:STE. 204
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-9660
Practice Address - Country:US
Practice Address - Phone:903-581-0933
Practice Address - Fax:903-581-3977
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23170103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115283704Medicaid
TX115283703Medicaid
TX115283703Medicaid
TX83378PMedicare PIN
TXP00197571Medicare PIN