Basic Information
Provider Information | |||||||||
NPI: | 1770878555 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ROCKETT | ||||||||
FirstName: | ERIN | ||||||||
MiddleName: | ELIZABETH | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 206 | ||||||||
Address2: |   | ||||||||
City: | RUSTON | ||||||||
State: | LA | ||||||||
PostalCode: | 712730206 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3182424645 | ||||||||
FaxNumber: | 3182424698 | ||||||||
Practice Location | |||||||||
Address1: | 622 RIVERSIDE DR | ||||||||
Address2: |   | ||||||||
City: | MONROE | ||||||||
State: | LA | ||||||||
PostalCode: | 712016211 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3183980945 | ||||||||
FaxNumber: | 3183984314 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/09/2011 | ||||||||
LastUpdateDate: | 06/04/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/03/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 2497 | LA | N |   | Behavioral Health & Social Service Providers | Counselor | Professional | 106H00000X | 231 | LA | N |   | Behavioral Health & Social Service Providers | Marriage & Family Therapist |   | 101Y00000X |   |   | Y |   | Behavioral Health & Social Service Providers | Counselor |   |
No ID Information.