Provider Demographics
NPI:1518792886
Name:CROCKETT, ERICA (LPC, NCC)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:CROCKETT
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 W PALOUSE ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-3534
Mailing Address - Country:US
Mailing Address - Phone:208-409-0158
Mailing Address - Fax:
Practice Address - Street 1:1813 W PALOUSE ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-3534
Practice Address - Country:US
Practice Address - Phone:208-409-0158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID9061774101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor