Erickson Psychological Services LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PS007918L Issued in PA

Legal business name

ERICKSON PSYCHOLOGICAL SERVICES LLC

Practice address

315 S Allen St
Suite 421
State College, PA 16801-4849

Phone

(814) 466-2133

NPI assigned

Feb 4, 2015

Organization subpart

No

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

Authorized official

Name

John Raymond Erickson, PHDNPI 1366434466

Title

Owner

Phone

(814) 466-2133

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John Raymond Erickson, PH.D.

  • Clinical Psychologist
  • State College, PA
  • NPI 1366434466
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1423008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423094400000",
    "number": "1679963193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 S ALLEN ST",
            "address_2": "SUITE 421",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168014849",
            "telephone_number": "814-466-2133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 S ALLEN ST",
            "address_2": "SUITE 421",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168014849",
            "telephone_number": "814-466-2133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ERICKSON PSYCHOLOGICAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-04",
        "last_updated": "2015-02-05",
        "status": "A",
        "authorized_official_last_name": "ERICKSON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "RAYMOND",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "814-466-2133",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "PA",
            "license": "PS007918L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• John Raymond Erickson, PH.D.
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• Susan Carol Eshelman, R.PH.
• Amanda C. Evans, M.S., L.P.C.

• Clinical Psychologist in State College, PA
• Providers in State College, PA by specialty
• Clinical Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.