1679749022 NPI number — MISS T AISHA EDWARDS MS, LPC

Table of content: MISS T AISHA EDWARDS MS, LPC (NPI 1679749022)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679749022 NPI number — MISS T AISHA EDWARDS MS, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EDWARDS
Provider First Name:
T
Provider Middle Name:
AISHA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MS, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679749022
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 E EVERGREEN BLVD
Provider Second Line Business Mailing Address:
219B
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98660-3129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-893-5931
Provider Business Mailing Address Fax Number:
503-894-9745

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 E EVERGREEN BLVD
Provider Second Line Business Practice Location Address:
219B
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98660-3331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-893-5931
Provider Business Practice Location Address Fax Number:
503-894-9745
Provider Enumeration Date:
05/06/2008

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: 101YP2500X , with the licence number:  C3146 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: LH60435776 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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