Provider Demographics
NPI:1861860959
Name:ERICKSON, SETH (LCSW, LSCSW)
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:LCSW, LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14410 W 78TH TER
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66216-4209
Mailing Address - Country:US
Mailing Address - Phone:618-521-8709
Mailing Address - Fax:847-881-3961
Practice Address - Street 1:14410 W 78TH TER
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66216-4209
Practice Address - Country:US
Practice Address - Phone:618-521-8709
Practice Address - Fax:847-881-3961
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-08
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490242951041C0700X
KSLSCSW063991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical