Healthcare Provider Details

I. General information

NPI: 1639087398
Provider Name (Legal Business Name): MATHEW EDWARDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23403 E MISSION AVE STE 103
LIBERTY LAKE WA
99019-7554
US

IV. Provider business mailing address

2835 W FRANCIS AVE
SPOKANE WA
99205-7134
US

V. Phone/Fax

Practice location:
  • Phone: 208-315-3917
  • Fax:
Mailing address:
  • Phone: 208-315-3917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMHCA.MC.70177370
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: