Provider Demographics
NPI:1700984226
Name:EHRICH, BRIAN (PSYD, LP)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:EHRICH
Suffix:
Gender:M
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9531 W 78TH ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3810
Mailing Address - Country:US
Mailing Address - Phone:612-382-7670
Mailing Address - Fax:952-944-1061
Practice Address - Street 1:9531 W EST 78TH STREET
Practice Address - Street 2:SUITE 110
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3810
Practice Address - Country:US
Practice Address - Phone:612-382-7670
Practice Address - Fax:952-944-1061
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3312103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN624522600Medicaid
MN68002500Medicare PIN