Healthcare Provider Details

I. General information

NPI: 1932614823
Provider Name (Legal Business Name): KRISTIN ERICKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 THE CITY DR S
ORANGE CA
92868-3205
US

IV. Provider business mailing address

405 W 5TH ST STE 658
SANTA ANA CA
92701-4599
US

V. Phone/Fax

Practice location:
  • Phone: 714-935-6706
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT100363
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: