Healthcare Provider Details

I. General information

NPI: 1528150802
Provider Name (Legal Business Name): MR. EDWARD DEAN LARK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 E 7TH ST MENTAL HEALTH SUBSTANCE ABUSE #006-116A
LONG BEACH CA
90822-5201
US

IV. Provider business mailing address

5901 E 7TH ST MENTAL HEALTH SUBSTANCE ABUSE #006-116A
LONG BEACH CA
90822-5201
US

V. Phone/Fax

Practice location:
  • Phone: 562-826-5610
  • Fax: 562-826-5431
Mailing address:
  • Phone: 562-826-5610
  • Fax: 562-826-5431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: