Provider Demographics
NPI:1932732997
Name:EDISON COUNSELING CENTER
Entity Type:Organization
Organization Name:EDISON COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AREASE
Authorized Official - Middle Name:N
Authorized Official - Last Name:EDISON
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, LMFT
Authorized Official - Phone:310-853-2758
Mailing Address - Street 1:879 W 190TH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-4223
Mailing Address - Country:US
Mailing Address - Phone:310-853-2758
Mailing Address - Fax:310-953-8420
Practice Address - Street 1:879 W 190TH ST STE 400
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-4223
Practice Address - Country:US
Practice Address - Phone:310-853-2758
Practice Address - Fax:909-456-8094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-19
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty