Provider Demographics
NPI:1033587902
Name:ERICKSON, CLARA A (LMFT)
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:A
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 PAGE DR S
Mailing Address - Street 2:STE 102A
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-3500
Mailing Address - Country:US
Mailing Address - Phone:701-446-6500
Mailing Address - Fax:
Practice Address - Street 1:1330 PAGE DR S
Practice Address - Street 2:STE 102A
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3500
Practice Address - Country:US
Practice Address - Phone:701-446-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2013-043106H00000X
MN2311106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist