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General NPI Number Information
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NPI Number | 1730765934
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Entity Type | Individual
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Provider Name | MARCUS EDWARD JOHN M.ED, CRC, LPC, LMHC
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Gender | Male
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Dates
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Enumeration Date | 03/19/2021
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 6400 SOUTHCENTER BLVD
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City | TUKWILA
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State | WA
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Zip | 98188-2547
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Country | US
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Telephone | 206-901-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 713 8TH AVENUE PL NW # 1
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City | PUYALLUP
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State | WA
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Zip | 98371-4126
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Country | US
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Telephone | 208-609-3606
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-7839
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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