Provider Demographics
NPI:1174625578
Name:MIDDLETON, ERICA S (PSYD)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:S
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ERICA
Other - Middle Name:S
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:8140 N MOPAC EXPY
Mailing Address - Street 2:STE 135
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8837
Mailing Address - Country:US
Mailing Address - Phone:512-201-4006
Mailing Address - Fax:
Practice Address - Street 1:8140 N MOPAC EXPY
Practice Address - Street 2:STE 135
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8837
Practice Address - Country:US
Practice Address - Phone:512-201-4006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35196103TC0700X
CA101276418103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool