Provider Demographics
NPI:1003122987
Name:ERIE, BRENDA JO (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:JO
Last Name:ERIE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 21ST ST W STE D-1
Mailing Address - Street 2:THERAPY SOLUTIONS
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-3462
Mailing Address - Country:US
Mailing Address - Phone:701-483-1000
Mailing Address - Fax:701-483-1001
Practice Address - Street 1:448 21ST ST W STE D1
Practice Address - Street 2:THERAPY SOLUTIONS
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-2647
Practice Address - Country:US
Practice Address - Phone:701-483-1000
Practice Address - Fax:701-483-1001
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND26681041C0700X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND4560002242Medicaid