Provider Demographics
NPI:1467098020
Name:PIERT, EDWYNA (LMFT)
Entity Type:Individual
Prefix:
First Name:EDWYNA
Middle Name:
Last Name:PIERT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21194
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90801-4194
Mailing Address - Country:US
Mailing Address - Phone:213-505-6236
Mailing Address - Fax:
Practice Address - Street 1:3840 WOODRUFF AVE STE 108
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-2148
Practice Address - Country:US
Practice Address - Phone:213-505-6236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA116468106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist