Healthcare Provider Details

I. General information

NPI: 1457275919
Provider Name (Legal Business Name): EDGAR W POWELL IV LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8755 FONTAINE ST
OAKLAND CA
94605-4141
US

IV. Provider business mailing address

1191 SOLANO AVENUE P.O. BOX 6217
ALBANY CA
94706
US

V. Phone/Fax

Practice location:
  • Phone: 973-299-9954
  • Fax:
Mailing address:
  • Phone: 973-299-9954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMFT164526
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: