Individual
MR. GEORGE DONALD ERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW, LCSW
Contact information
Practice address
340 KELLEY PKWY, MEXICO, MO 65265
(573) 582-1234
(573) 582-1212
Mailing address
340 KELLEY PKWY, MEXICO, MO 65265-3811
(573) 582-1234
(573) 582-1212
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2005031912
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
497474502
—
MO
Enumeration date
10/26/2005
Last updated
09/09/2019
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