Provider Demographics
NPI:1124142138
Name:ERICKSON, KYLE G (MS, LMFT)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:G
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22142 SE 237TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-8534
Mailing Address - Country:US
Mailing Address - Phone:425-224-2494
Mailing Address - Fax:
Practice Address - Street 1:22142 SE 237TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-8534
Practice Address - Country:US
Practice Address - Phone:425-224-2494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00002271106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist