Healthcare Provider Details

I. General information

NPI: 1285191312
Provider Name (Legal Business Name): CHRISTIAN ERIC ERLENBUSH LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 TERMINAL WAY STE 172
RENO NV
89502-2179
US

IV. Provider business mailing address

1344 DISC DR # 3127
SPARKS NV
89436-0684
US

V. Phone/Fax

Practice location:
  • Phone: 949-603-2314
  • Fax: 949-619-8133
Mailing address:
  • Phone: 949-603-2314
  • Fax: 949-619-8133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11948-C
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number82956
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.020877
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: