Provider Demographics
NPI:1053053934
Name:DEHERRERA, EDWARD (SUDPT)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:DEHERRERA
Suffix:
Gender:M
Credentials:SUDPT
Other - Prefix:
Other - First Name:EDDY
Other - Middle Name:
Other - Last Name:DEHERRERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:140 S ARTHUR ST STE 400
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2220
Mailing Address - Country:US
Mailing Address - Phone:509-532-8855
Mailing Address - Fax:509-532-8844
Practice Address - Street 1:140 S ARTHUR STREET, SUITE 400
Practice Address - Street 2:SUITE 400
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-9920
Practice Address - Country:US
Practice Address - Phone:509-532-8855
Practice Address - Fax:509-532-8844
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAC061261876101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACO61261876OtherINSURANCE BILLING