Provider Demographics
NPI:1487945861
Name:REISS, ERICK LAWRENCE (MA, LMFT)
Entity type:Individual
Prefix:MR
First Name:ERICK
Middle Name:LAWRENCE
Last Name:REISS
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 S WESTERN AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108
Mailing Address - Country:US
Mailing Address - Phone:605-212-9684
Mailing Address - Fax:605-332-1723
Practice Address - Street 1:5201 S WESTERN AVE STE 105
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108
Practice Address - Country:US
Practice Address - Phone:605-212-9684
Practice Address - Fax:605-332-1723
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLAMFT 1783106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist