Individual provider Active NPI

Jeanne Erikson, LSCSW

  • Mental Health Counselor
  • Wichita, KS
National Provider Identifier
1063512739
Registry record updated Jun 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
1633 Issued in KS
Practice address
200 W Douglas Ave Ste 560
Wichita, KS 67202-3020
Phone
(316) 269-2322
Fax
(316) 269-2448
NPI assigned
Sep 23, 2006
Last updated
Jun 16, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 1633 KS Primary

Addresses

Primary practice location

200 W Douglas Ave Ste 560
Wichita, KS 67202-3020

Mailing address

200 W Douglas Ave
Ste 555
Wichita, KS 67202-3007
Phone (316) 776-2317

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040305000709 KS Practitioner - Clinical Social Worker 1658269238

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1633KSMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Counseling and Mediation Center, Inc. PastSince Jul 1, 2003 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592265600000",
    "number": "1063512739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 W DOUGLAS AVE",
            "address_2": "STE 555",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672023007",
            "telephone_number": "316-776-2317",
            "fax_number": "833-377-0520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W DOUGLAS AVE STE 560",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672023020",
            "telephone_number": "316-269-2322",
            "fax_number": "316-269-2448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ERIKSON",
        "first_name": "JEANNE",
        "credential": "LSCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-23",
        "last_updated": "2020-06-16",
        "certification_date": "2020-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "KS",
            "license": "1633",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wichita, KS

Sources for this page

Verify at the official NPI Registry.