Healthcare Provider Details

I. General information

NPI: 1487213138
Provider Name (Legal Business Name): EDGE PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 N FRANKLIN ST
DENVER CO
80218-1624
US

IV. Provider business mailing address

1575 N FRANKLIN ST
DENVER CO
80218-1624
US

V. Phone/Fax

Practice location:
  • Phone: 510-367-8965
  • Fax:
Mailing address:
  • Phone: 510-367-8965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ERIC A EICHLER
Title or Position: OWNER/THERAPIST
Credential: LCSW
Phone: 510-367-8965