Provider Demographics
NPI:1003237298
Name:EDWARDS PSYCHOTHERAPY, P.C.
Entity type:Organization
Organization Name:EDWARDS PSYCHOTHERAPY, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVIN-EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-222-0557
Mailing Address - Street 1:1220 SW MORRISON ST
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2235
Mailing Address - Country:US
Mailing Address - Phone:503-222-0557
Mailing Address - Fax:
Practice Address - Street 1:1220 SW MORRISON ST
Practice Address - Street 2:SUITE 1100
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2235
Practice Address - Country:US
Practice Address - Phone:503-222-0557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-15
Last Update Date:2013-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty