Provider Demographics
NPI:1306195540
Name:ERICKSON, CASSIDY STOVER (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:CASSIDY
Middle Name:STOVER
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:CASSIDY
Other - Middle Name:LEIGH
Other - Last Name:STOVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:4891 INDEPENDENCE ST
Mailing Address - Street 2:SUITE #165
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6752
Mailing Address - Country:US
Mailing Address - Phone:303-456-0600
Mailing Address - Fax:303-456-0607
Practice Address - Street 1:4891 INDEPENDENCE ST
Practice Address - Street 2:SUITE #165
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6752
Practice Address - Country:US
Practice Address - Phone:303-456-0600
Practice Address - Fax:303-456-0607
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1040106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist