Provider Demographics
NPI:1558580373
Name:ERICKSON, DEBRA KAY (MA)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:KAY
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 S LOCUST ST STE F
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-8200
Mailing Address - Country:US
Mailing Address - Phone:308-398-0350
Mailing Address - Fax:308-398-0351
Practice Address - Street 1:1300 S LOCUST ST STE F
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-8200
Practice Address - Country:US
Practice Address - Phone:308-398-0350
Practice Address - Fax:308-398-0351
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE493101YA0400X
NE2352101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE84017OtherBCBS
NE353262000OtherMAGELLAN