| Doctor Name: | DR. EDWIN B. BOTTUM-MORGAN |
| NPI Number: | 1225119456 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | PSY9703 |
| Business Practice Address: | 100 Tamal Plz Ste 195 Corte Madera, CA - 949251181 |
| Business Phone Number: | 4159274800 |
| Business Fax Number: | |
| Mailing Address: | 100 Tamal Plz Ste 195, CORTE MADERA |
| State: | CA |
| Postal Code: | 949251181 |
| Phone Number: | 4159274800 |
| Fax Number: | |
| NPI Enumeration Date: | 10/17/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PSY9703 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |