Provider Demographics
NPI:1689208860
Name:JASON ERICKSON LCP LLC
Entity Type:Organization
Organization Name:JASON ERICKSON LCP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCP
Authorized Official - Phone:620-481-1311
Mailing Address - Street 1:1333 N SPLIT RAIL CT
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-2846
Mailing Address - Country:US
Mailing Address - Phone:620-481-1311
Mailing Address - Fax:
Practice Address - Street 1:250 N ROCK RD STE 370
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2243
Practice Address - Country:US
Practice Address - Phone:620-481-1311
Practice Address - Fax:316-333-7281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty