Provider Demographics
NPI:1548394695
Name:BUIE, EDITH A (MFT)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:A
Last Name:BUIE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MRS
Other - First Name:EDITH
Other - Middle Name:A
Other - Last Name:BUIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:10881 ARIZONA AVE
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-3725
Mailing Address - Country:US
Mailing Address - Phone:310-508-6706
Mailing Address - Fax:310-842-9573
Practice Address - Street 1:10881 ARIZONA AVE
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-3725
Practice Address - Country:US
Practice Address - Phone:310-508-6706
Practice Address - Fax:310-842-9573
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC23182106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist