Provider Demographics
NPI:1164776704
Name:NIGHTWALKER, EDITH RUTH
Entity Type:Individual
Prefix:MISS
First Name:EDITH
Middle Name:RUTH
Last Name:NIGHTWALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:EDITH
Other - Middle Name:NIGHTWALKER
Other - Last Name:LITTLEHEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CADCII
Mailing Address - Street 1:P.O. BOX 67
Mailing Address - Street 2:100 EAGLE FEATHERS STREET
Mailing Address - City:LAME DEER,
Mailing Address - State:MT
Mailing Address - Zip Code:59043
Mailing Address - Country:US
Mailing Address - Phone:406-477-4924
Mailing Address - Fax:406-477-6727
Practice Address - Street 1:100 EAGLE FEATHERS DRIVE
Practice Address - Street 2:
Practice Address - City:LAME DEER
Practice Address - State:MT
Practice Address - Zip Code:59043
Practice Address - Country:US
Practice Address - Phone:406-477-6381
Practice Address - Fax:406-477-6727
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ201101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)