Provider Demographics
NPI:1912091851
Name:RASK, ERICK C (LPC)
Entity type:Individual
Prefix:
First Name:ERICK
Middle Name:C
Last Name:RASK
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 419
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85929-0419
Mailing Address - Country:US
Mailing Address - Phone:928-532-1498
Mailing Address - Fax:928-532-1498
Practice Address - Street 1:145 N WHITE MOUNTAIN RD STE D
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-5232
Practice Address - Country:US
Practice Address - Phone:928-532-1498
Practice Address - Fax:928-532-1498
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health