Active NPI
Edward John Northam, PH.D.
- Professional Counselor
- Nampa, ID
National Provider Identifier
1326059072
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 5698
- Practice address
- 923 16TH Ave S
Nampa, ID 83651-4731 - Phone
- (208) 965-8788
- Fax
- (208) 965-2789
- NPI assigned
- Aug 10, 2006
- Last updated
- Nov 18, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 406 | NE | |
| Professional Counselor | 101YP2500X | 5698 | ID | Primary |
Addresses
Primary practice location
923 16TH Ave S
Nampa, ID 83651-4731
Mailing address
923 16TH Ave S
Nampa, ID 83651-4731
Phone (208) 965-8788
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 84913 | Other | NE | BLUE CROSS BLUE SHIELD |
| 114961 | Other | NE | VALUE OPTIONS |
| 91185390827 | Medicaid | NE | |
| 345988000 | Other | NE | MAGELLAN |
| 91185390826 | Medicaid | NE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 406 | NE | MD | Addiction (Substance Use Disorder) Counselor |
| 5698 | ID | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1447804800000",
"number": "1326059072",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "923 16TH AVE S",
"city": "NAMPA",
"state": "ID",
"postal_code": "836514731",
"telephone_number": "208-965-8788",
"fax_number": "208-965-2789"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "923 16TH AVE S",
"city": "NAMPA",
"state": "ID",
"postal_code": "836514731",
"telephone_number": "208-965-8788",
"fax_number": "208-965-2789"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NORTHAM",
"first_name": "EDWARD",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-10",
"last_updated": "2015-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NE",
"license": "406",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "ID",
"license": "5698",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "84913",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "114961",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "91185390827",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN",
"identifier": "345988000",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "91185390826",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Nampa, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.