Healthcare Provider Details

I. General information

NPI: 1245140755
Provider Name (Legal Business Name): ASHA BETINA EDSON
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11279 PERRY HWY
WEXFORD PA
15090-9381
US

IV. Provider business mailing address

5814 JACKSON ST
PITTSBURGH PA
15206-2115
US

V. Phone/Fax

Practice location:
  • Phone: 724-933-1031
  • Fax:
Mailing address:
  • Phone: 650-847-7005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: