| Doctor Name: | DR. KEITH JOHN EDWARDS |
| NPI Number: | 1164636056 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | PSY10082 |
| Business Practice Address: | 12625 La Mirada Blvd Suite 202 La Mirada, CA - 906382211 |
| Business Phone Number: | 5629034800 |
| Business Fax Number: | 5629034802 |
| Mailing Address: | 3005 Gotera Dr, HACIENDA HEIGHTS |
| State: | CA |
| Postal Code: | 917456613 |
| Phone Number: | 6269687075 |
| Fax Number: | 5629034864 |
| NPI Enumeration Date: | 05/09/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PSY10082 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |