Provider Demographics
NPI:1649502204
Name:AVERETT, EDWARD J (MS, CSOTP)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:J
Last Name:AVERETT
Suffix:
Gender:M
Credentials:MS, CSOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 S WASHINGTON ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-3719
Mailing Address - Country:US
Mailing Address - Phone:509-533-6768
Mailing Address - Fax:509-328-9909
Practice Address - Street 1:9 S WASHINGTON ST
Practice Address - Street 2:SUITE 215
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-3719
Practice Address - Country:US
Practice Address - Phone:509-533-6768
Practice Address - Fax:509-328-9909
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006038101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health