Healthcare Provider Details

I. General information

NPI: 1033587902
Provider Name (Legal Business Name): CLARA A ERICKSON LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 09/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 PAGE DR S STE 102A
FARGO ND
58103-3500
US

IV. Provider business mailing address

1330 PAGE DR S STE 102A
FARGO ND
58103-3500
US

V. Phone/Fax

Practice location:
  • Phone: 701-446-6500
  • Fax:
Mailing address:
  • Phone: 701-446-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2013-043
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2311
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: