Provider Demographics
NPI:1104959469
Name:EDELHAUS, NATASHA (LMFT)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:EDELHAUS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:756 WASHINGTON ST STE B
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-2976
Mailing Address - Country:US
Mailing Address - Phone:781-708-4504
Mailing Address - Fax:
Practice Address - Street 1:9935 ALCOSTA BLVD
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-3057
Practice Address - Country:US
Practice Address - Phone:781-864-0539
Practice Address - Fax:925-999-9627
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA059909106H00000X
CALMFT40591106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1104959469OtherLYRA HEALTH
1104959469OtherCIGNA
1104959469OtherBLUE CROSS BLUE SHIELD OF CA
1104959469OtherMAGELLAN
1104959469OtherAETNA HEALTH
1104959469OtherUNITED HEALTHCARE
1104959469OtherUMR