Provider Demographics
NPI:1104330406
Name:ANDERSON, ERIK (LMFT)
Entity type:Individual
Prefix:MR
First Name:ERIK
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10866 WASHINGTON BLVD # 97
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-3610
Mailing Address - Country:US
Mailing Address - Phone:323-283-9207
Mailing Address - Fax:
Practice Address - Street 1:11949 JEFFERSON BLVD STE 102
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90230-6336
Practice Address - Country:US
Practice Address - Phone:323-283-9207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-22
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF82844106H00000X
CA111230106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist