Provider Demographics
NPI:1265981823
Name:LUSSIER-ERICKSON, KATRINA CARLENE (MA, LMFT)
Entity type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:CARLENE
Last Name:LUSSIER-ERICKSON
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 3RD AVENUE SW
Mailing Address - Street 2:
Mailing Address - City:PINE CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55063-1443
Mailing Address - Country:US
Mailing Address - Phone:320-629-0059
Mailing Address - Fax:320-629-9983
Practice Address - Street 1:645 3RD AVENUE SW
Practice Address - Street 2:
Practice Address - City:PINE CITY
Practice Address - State:MN
Practice Address - Zip Code:55063-1443
Practice Address - Country:US
Practice Address - Phone:320-629-0059
Practice Address - Fax:320-629-9983
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN306076LADC101YA0400X
MN3147106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist