=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104959469
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATASHA EDELHAUS LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2007
-----------------------------------------------------
Last Update Date | 07/17/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9935 ALCOSTA BLVD
-----------------------------------------------------
City | SAN RAMON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94583-3057
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-864-0539
-----------------------------------------------------
Fax | 925-999-9627
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 756 WASHINGTON ST STE B
-----------------------------------------------------
City | STOUGHTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02072-2976
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-708-4504
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 059909
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | LMFT40591
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------