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:
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Health care specialties

SpecialtyCodeLicense #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 2 years ago

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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1285878413 NPPES
Michigan MEDICAID 1708146

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