Lilli Edson, MA

Key facts

NPI

1275883308

Entity type

Individual (NPI type 1)

Primary specialty

Marriage & Family Therapist 106H00000X

License

100196 (CA)

Practice address

1152 S Main St
Lakeport, CA 95453-5517

Phone

(707) 263-8795

NPI assigned

Sep 17, 2012

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Master of Arts

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 21, 2018.

{
    "created_epoch": "1347840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537488000000",
    "number": "1275883308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1152 S MAIN ST",
            "city": "LAKEPORT",
            "state": "CA",
            "postal_code": "954535517",
            "telephone_number": "707-262-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1152 S MAIN ST",
            "city": "LAKEPORT",
            "state": "CA",
            "postal_code": "954535517",
            "telephone_number": "707-263-8795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDSON",
        "first_name": "LILLI",
        "credential": "MA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-09-17",
        "last_updated": "2018-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "100196",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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