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Individual

DR. EDWARD JOHN NORTHAM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PH.D.

Contact information

Practice address
923 16TH AVE S, NAMPA, ID 83651-4731
(208) 965-8788
(208) 965-2789
Mailing address
923 16TH AVE S, NAMPA, ID 83651-4731
(208) 965-8788
(208) 965-2789

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
406
NE
101YP2500X
Professional Counselor
Primary
5698
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
114961
VALUE OPTIONS
NE
01
345988000
MAGELLAN
NE
01
84913
BLUE CROSS BLUE SHIELD
NE
05
91185390826
NE
05
91185390827
NE
Enumeration date
08/10/2006
Last updated
11/18/2015
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