Ericksen, Travis James
Ericksen, Travis James is an individual health care provider with primary practice located at 6100 Newport Rd Ste 222 , Portage MI 49002-9235. He recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as his primary health care specialty. Ericksen, Travis James can be contacted via phone (269) 488-5929.Contact Information
Primary practice address
6100 Newport Rd Ste 222
Portage MI 49002-9235
Phone: (269) 488-5929
Fax: (833) 599-7700
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Behavioral Health & Social Service Providers / Professional | 101YP2500X | 6401010965 | Michigan |
Profile Details
NPI number | 1285878413 |
---|---|
LBN Legal business name | Ericksen, Travis James |
Credentials | Licensed Professional Counselor (LPC) |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | May 1st, 2009 |
Last updated | Sep 7th, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1285878413 | NPPES |
Michigan | MEDICAID | 1708146 |
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