Provider Demographics
NPI:1629131024
Name:EDD, NICHOLAS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:EDD
Suffix:
Gender:M
Credentials:PSYD
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 66118
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77266-6118
Mailing Address - Country:US
Mailing Address - Phone:281-558-6231
Mailing Address - Fax:281-558-6379
Practice Address - Street 1:11767 KATY FWY
Practice Address - Street 2:SUITE 715
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-1716
Practice Address - Country:US
Practice Address - Phone:281-558-6231
Practice Address - Fax:281-558-6379
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23060103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0856049-01Medicaid
TX0856049-01Medicaid