Provider Demographics
NPI:1013367804
Name:CABLES, ERICKA RENEE
Entity Type:Individual
Prefix:
First Name:ERICKA
Middle Name:RENEE
Last Name:CABLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERICKA
Other - Middle Name:RENEE
Other - Last Name:BASSETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2553 HACKMAN DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-5836
Mailing Address - Country:US
Mailing Address - Phone:314-704-8190
Mailing Address - Fax:314-227-9331
Practice Address - Street 1:11520 SAINT CHARLES ROCK RD STE 101
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2732
Practice Address - Country:US
Practice Address - Phone:314-312-2551
Practice Address - Fax:314-227-9331
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015030521101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health