Provider Demographics
NPI:1043438500
Name:ERICKSON, MICHAEL R (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:ERICKSON
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 1:50 FULLERTON CT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6205
Mailing Address - Country:US
Mailing Address - Phone:916-572-5254
Mailing Address - Fax:916-265-6390
Practice Address - Street 1:50 FULLERTON CT
Practice Address - Street 2:SUITE 200
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6205
Practice Address - Country:US
Practice Address - Phone:916-572-5254
Practice Address - Fax:916-265-6390
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2014-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY4438103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA170880600Medicare UPIN