Doctor Name: | CRAIG KENDALL EDMONDSON |
NPI Number: | 1003186016 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | BS ED BHRS |
License Number: | |
Business Practice Address: | 801 E Main St Tishomingo, OK - 734602351 |
Business Phone Number: | 5803713776 |
Business Fax Number: | |
Mailing Address: | 84 Pecan St, DURANT |
State: | OK |
Postal Code: | 747017400 |
Phone Number: | 9032936466 |
Fax Number: | |
NPI Enumeration Date: | 01/06/2012 |
NPI Last Update Date: | 01/06/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |