Provider Demographics
NPI:1508323544
Name:ERICKSON, LUCILLE MARGUERITE
Entity Type:Individual
Prefix:
First Name:LUCILLE
Middle Name:MARGUERITE
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2360 E EVANS AVE APT 1148
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-4773
Mailing Address - Country:US
Mailing Address - Phone:952-217-3601
Mailing Address - Fax:
Practice Address - Street 1:948 N LOGAN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-5704
Practice Address - Country:US
Practice Address - Phone:952-217-3601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health