1336832146 NPI number — CECILIA WHARTON ERLUND EDD LPC

Table of content: CECILIA WHARTON ERLUND EDD LPC (NPI 1336832146)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336832146 NPI number — CECILIA WHARTON ERLUND EDD LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ERLUND
Provider First Name:
CECILIA
Provider Middle Name:
WHARTON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
EDD LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ERLUND
Provider Other First Name:
CECILIA
Provider Other Middle Name:
WHARTON
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
EDD LPC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1336832146
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 310
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOODY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76557-0310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-624-7889
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13133 FM 2601 #300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOODY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-624-7889
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/29/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  8574 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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