Provider Demographics
NPI:1205077237
Name:ERICKSON, LISA M (LCSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 SW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-3749
Mailing Address - Country:US
Mailing Address - Phone:816-500-2774
Mailing Address - Fax:816-525-2146
Practice Address - Street 1:2308 SW 10TH ST
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-3749
Practice Address - Country:US
Practice Address - Phone:816-500-2774
Practice Address - Fax:816-525-2146
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-22
Last Update Date:2009-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008036829101YM0800X
KS5733101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health