Individual
JACOB ERICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MT-BC
Contact information
Practice address
4220 N GRAND BLVD, SAINT LOUIS, MO 63107-1831
(314) 534-6624
Mailing address
4220 N GRAND BLVD, SAINT LOUIS, MO 63107-1831
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
11/10/2015
Last updated
11/10/2015
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