Provider Demographics
NPI:1174513550
Name:ERICKSON, M. LLOYD (PHD)
Entity type:Individual
Prefix:DR
First Name:M.
Middle Name:LLOYD
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:LLOYD
Other - Middle Name:
Other - Last Name:ERICKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:9 HERITAGE OAK LN
Mailing Address - Street 2:STE 9
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-4281
Mailing Address - Country:US
Mailing Address - Phone:269-979-4800
Mailing Address - Fax:
Practice Address - Street 1:9 HERITAGE OAK LN
Practice Address - Street 2:STE 9
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-4281
Practice Address - Country:US
Practice Address - Phone:269-979-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006684103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0A34540Medicare ID - Type Unspecified