Basic Information
| Provider Information | |||||||||
| NPI: | 1346682036 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ERICKSON | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | LMSW, IADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3004 30TH ST | ||||||||
| Address2: | |||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503105259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152776399 | ||||||||
| FaxNumber: | 8442705729 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 SW ANKENY RD | ||||||||
| Address2: | |||||||||
| City: | ANKENY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 500239702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152892272 | ||||||||
| FaxNumber: | 5152890156 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2013 | ||||||||
| LastUpdateDate: | 03/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 13066 | IA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | 008266 | IA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.