Provider Demographics
NPI:1134576200
Name:EDWARDS, NATHANIEL KING (LMFT)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:KING
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7641 UNIVERSITY AVE UNIT 107
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-6217
Mailing Address - Country:US
Mailing Address - Phone:619-865-1926
Mailing Address - Fax:
Practice Address - Street 1:7641 UNIVERSITY AVE UNIT 107
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-6217
Practice Address - Country:US
Practice Address - Phone:619-865-1926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2025-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA126890106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist