Healthcare Provider Details

I. General information

NPI: 1275469736
Provider Name (Legal Business Name): NYX MAEVE EVERLY LMCHA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ANDREW JAMES POULESON

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 W RIVERSIDE AVE STE N
SPOKANE WA
99201-0581
US

IV. Provider business mailing address

522 W RIVERSIDE AVE STE N
SPOKANE WA
99201-0581
US

V. Phone/Fax

Practice location:
  • Phone: 253-234-1987
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHCA.MC.70040453
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: