Doctor Name: | DEBORAH KAYE EDWARDS |
NPI Number: | 1366802514 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PLPC |
License Number: | 178011822 |
Business Practice Address: | 5016 N Illinois St Suite A Fairview Heights, IL - 622083411 |
Business Phone Number: | 6183987250 |
Business Fax Number: | 6182346311 |
Mailing Address: | 5016 N Illinois St, Suite A FAIRVIEW HEIGHTS |
State: | IL |
Postal Code: | 622083411 |
Phone Number: | 6183987250 |
Fax Number: | 6182346311 |
NPI Enumeration Date: | 03/01/2016 |
NPI Last Update Date: | 03/01/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 178011822 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |