Provider Demographics
NPI:1023633898
Name:JEANNE ERIKSON COUNSELING AND COACHING LLC
Entity type:Organization
Organization Name:JEANNE ERIKSON COUNSELING AND COACHING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ERIKSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD LSCSW
Authorized Official - Phone:316-776-8917
Mailing Address - Street 1:200 W DOUGLAS AVE STE 555
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-3007
Mailing Address - Country:US
Mailing Address - Phone:316-776-2317
Mailing Address - Fax:833-377-0520
Practice Address - Street 1:200 W DOUGLAS AVE STE 555
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-3007
Practice Address - Country:US
Practice Address - Phone:316-776-2317
Practice Address - Fax:833-377-0520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-08
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS536-103-5OtherLLC ID NUMBER
KS0044759Medicaid
KS1633OtherLICENSED SPECIALIST CLINICAL SOCIAL WORKER