Healthcare Provider Details

I. General information

NPI: 1346826765
Provider Name (Legal Business Name): NEELAM THERESE EDWARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 N LAKE AVE STE 150
PASADENA CA
91104-2388
US

IV. Provider business mailing address

1450 N LAKE AVE STE 150
PASADENA CA
91104-2388
US

V. Phone/Fax

Practice location:
  • Phone: 310-854-2202
  • Fax: 626-794-6071
Mailing address:
  • Phone: 310-854-2202
  • Fax: 626-794-6071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: