Provider Demographics
NPI:1013380625
Name:ERICKSON, CHRISTINE (MA, CMHC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:MA, CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 E TABERNACLE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-2979
Mailing Address - Country:US
Mailing Address - Phone:435-688-1111
Mailing Address - Fax:
Practice Address - Street 1:435 E TABERNACLE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-2979
Practice Address - Country:US
Practice Address - Phone:435-688-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-04
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT267963-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health