Provider Demographics
NPI:1184146417
Name:ERICKSON, BETH ELLEN (LCSW)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:ELLEN
Last Name:ERICKSON
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25290 TRINITY ST
Mailing Address - Street 2:
Mailing Address - City:VENETA
Mailing Address - State:OR
Mailing Address - Zip Code:97487-8742
Mailing Address - Country:US
Mailing Address - Phone:971-384-5262
Mailing Address - Fax:
Practice Address - Street 1:245 DEANN DR APT 4
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OR
Practice Address - Zip Code:97351-2569
Practice Address - Country:US
Practice Address - Phone:541-536-3435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical