Provider Demographics
NPI:1043749443
Name:EDWARDS, FREDERICK PALTRON (CDPT)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:PALTRON
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:CDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 FRONT ST S STE 100
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-9415
Mailing Address - Country:US
Mailing Address - Phone:253-584-3996
Mailing Address - Fax:253-589-1071
Practice Address - Street 1:9500 FRONT STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499
Practice Address - Country:US
Practice Address - Phone:253-584-3996
Practice Address - Fax:253-589-1071
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60624643101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)