Provider Demographics
NPI:1508056177
Name:PROTHERO, EDWARD (MS LMFT)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:
Last Name:PROTHERO
Suffix:
Gender:M
Credentials:MS LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 COLUSA AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-4148
Mailing Address - Country:US
Mailing Address - Phone:530-755-0735
Mailing Address - Fax:530-755-0737
Practice Address - Street 1:438 COLUSA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-4148
Practice Address - Country:US
Practice Address - Phone:530-755-0735
Practice Address - Fax:530-755-0737
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 51165106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7034Medicare PIN