Provider Demographics
NPI:1427183094
Name:ERICKSON, LEE BRADLEY (MA, LPCC)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:BRADLEY
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2136 FORD PKWY # 130
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-1863
Mailing Address - Country:US
Mailing Address - Phone:651-234-0891
Mailing Address - Fax:651-234-0892
Practice Address - Street 1:557 7TH ST W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-3065
Practice Address - Country:US
Practice Address - Phone:651-234-0891
Practice Address - Fax:651-234-0892
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLPCC00111101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health