Provider Demographics
NPI:1730511551
Name:WEA, EDWIN JONATHAN (MA, LMHC)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:JONATHAN
Last Name:WEA
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3622 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2114
Mailing Address - Country:US
Mailing Address - Phone:253-761-1340
Mailing Address - Fax:
Practice Address - Street 1:6424 N 9TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-2091
Practice Address - Country:US
Practice Address - Phone:253-565-4484
Practice Address - Fax:253-565-5823
Is Sole Proprietor?:No
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006859101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health