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NPI Code Detail

MEDICARE: DESERAE ERICKSON

MEDICARE: DESERAE ERICKSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorKY

General Provider Information

NPI Number : 1245165513
Entity Type Code : Individual
Provider Name (Legal Business Name) : DESERAE ERICKSON
Provider Business Mailing Address
First Line : 107 CRANES ROOST CT
Second Line :
City : ELIZABETHTOWN
State : KY
Zip : 42701-3650
Country : US
Telephone Number : 270-765-2605
Fax Number :
Provider Business Practice Location Address
First Line : 107 CRANES ROOST CT
Second Line :
City : ELIZABETHTOWN
State : KY
Zip : 42701-3650
Country : US
Telephone Number : 270-765-2605
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2026
Last Update Date : 06/16/2026

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Directions to “ DESERAE ERICKSON ” Practice Location

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