MEDICARE: MS. ETHEL L EDWARDS LMFT, LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	4046	TX
2	104100000X	Social Worker	06246	TX
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	281	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184895062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ETHEL L EDWARDS LMFT, LMSW

Provider Business Mailing Address
First Line	:	PO BOX 460429
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78246-0429
Country	:	US
Telephone Number	:	210-446-8255
Fax Number	:	888-823-3497

Provider Business Practice Location Address
First Line	:	7300 BLANCO RD
Second Line	:	SUITE 501
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-4936
Country	:	US
Telephone Number	:	210-446-8255
Fax Number	:	888-823-3497

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2008
Last Update Date	:	09/29/2016

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