Provider Demographics
NPI:1659591352
Name:EWE, EDWARD (PHD, LMHC, LPC, NCC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:EWE
Suffix:
Gender:M
Credentials:PHD, LMHC, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19550 AMBER MEADOW DR STE 130-226
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3525
Mailing Address - Country:US
Mailing Address - Phone:425-654-0424
Mailing Address - Fax:
Practice Address - Street 1:1133 NW WALL STREET
Practice Address - Street 2:SUITE 1, EXECUTIVE SUITE 8
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702
Practice Address - Country:US
Practice Address - Phone:425-654-0424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60807650101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional