Provider Demographics
NPI:1629345004
Name:ZEBOOLOON, EDAN (MA, LMHCA)
Entity Type:Individual
Prefix:
First Name:EDAN
Middle Name:
Last Name:ZEBOOLOON
Suffix:
Gender:M
Credentials:MA, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 N 160TH ST.
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-5713
Mailing Address - Country:US
Mailing Address - Phone:206-841-0137
Mailing Address - Fax:
Practice Address - Street 1:316 MAIN STREET
Practice Address - Street 2:SUITE B
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3197
Practice Address - Country:US
Practice Address - Phone:206-841-0137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60163828101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
12278259OtherAETNA