Jeremy Erickson, MAMFTC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

2608 Issued in MS

Practice address

232 Goodman Rd W Ste 305
Southaven, MS 38671-8004

Phone

(662) 856-9563

NPI assigned

Aug 16, 2018

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

University of Tennessee, HSC, College of Medicine

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Salt and Light Counseling LLC

  • Mental Health Counselor
  • Southaven, MS
  • NPI 1356104004

  Single Specialty

  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1534377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712102400000",
    "number": "1396225504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "232 GOODMAN RD W STE 305",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386718004",
            "telephone_number": "662-856-9563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "232 GOODMAN RD W STE 305",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386718004",
            "telephone_number": "662-856-9563"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "120 Meghan Ln",
            "address_purpose": "LOCATION",
            "city": "Judsonia",
            "state": "AR",
            "postal_code": "720819302",
            "country_code": "US",
            "telephone_number": "501-729-1730",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5740 Getwell Rd Ste D",
            "address_purpose": "LOCATION",
            "city": "Southaven",
            "state": "MS",
            "postal_code": "386726346",
            "country_code": "US",
            "telephone_number": "601-790-0583",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ERICKSON",
        "first_name": "JEREMY",
        "credential": "MAMFTC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-08-16",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MS",
            "license": "2608",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "AR",
            "license": "A1708258",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Southaven, MS
• Providers in Southaven, MS by specialty
• Professional Counselor in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.