Provider Demographics
NPI:1689449845
Name:MACIAS, EDWARD CHRISTOPHER (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:CHRISTOPHER
Last Name:MACIAS
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 TIMBERLOCH PL STE 200
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1182
Mailing Address - Country:US
Mailing Address - Phone:832-377-5121
Mailing Address - Fax:
Practice Address - Street 1:450 ALASKAN WAY S STE 200
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2785
Practice Address - Country:US
Practice Address - Phone:832-377-5121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1134073363LP0808X
WAAP61478409363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health