Doctor Name: | KAREN JEAN EDGELL |
NPI Number: | 1033389143 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS,CAS,NCSP |
License Number: | |
Business Practice Address: | 200 Gaston Ave Fairmont, WV - 265542739 |
Business Phone Number: | 3046246554 |
Business Fax Number: | 3046245223 |
Mailing Address: | 200 Gaston Ave, FAIRMONT |
State: | WV |
Postal Code: | 265542739 |
Phone Number: | 3046246554 |
Fax Number: | 3046245223 |
NPI Enumeration Date: | 03/04/2008 |
NPI Last Update Date: | 03/04/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TS0200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WV |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | School |
Taxonomy Definition: |