1306195540 NPI number — CASSIDY STOVER ERICKSON MS, LMFT

Table of content: CASSIDY STOVER ERICKSON MS, LMFT (NPI 1306195540)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306195540 NPI number — CASSIDY STOVER ERICKSON MS, LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ERICKSON
Provider First Name:
CASSIDY
Provider Middle Name:
STOVER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STOVER
Provider Other First Name:
CASSIDY
Provider Other Middle Name:
LEIGH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1306195540
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4891 INDEPENDENCE ST
Provider Second Line Business Mailing Address:
SUITE #165
Provider Business Mailing Address City Name:
WHEAT RIDGE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80033-6752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-456-0600
Provider Business Mailing Address Fax Number:
303-456-0607

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4891 INDEPENDENCE ST
Provider Second Line Business Practice Location Address:
SUITE #165
Provider Business Practice Location Address City Name:
WHEAT RIDGE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80033-6752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-456-0600
Provider Business Practice Location Address Fax Number:
303-456-0607
Provider Enumeration Date:
09/04/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  1040 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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