Provider Demographics
NPI:1093929101
Name:ALVARADO, EDWARD C (LCDC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:C
Last Name:ALVARADO
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 RALEIGH CT APT 609
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-3394
Mailing Address - Country:US
Mailing Address - Phone:432-528-3537
Mailing Address - Fax:432-570-3375
Practice Address - Street 1:502 N CARVER ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-3634
Practice Address - Country:US
Practice Address - Phone:432-570-3390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBCBSOther8651BH