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NPI Code Detail

MEDICARE: DR. YVONNE J. EDWARDS LPC

MEDICARE: DR. YVONNE J. EDWARDS LPC
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
1101YP2500XProfessional CounselorC3376OR
2106H00000XMarriage & Family TherapistMFC24401CA

General Provider Information

NPI Number : 1366862435
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. YVONNE J. EDWARDS LPC
Provider Business Mailing Address
First Line : 3862 FRANKLIN AVE
Second Line :
City : ASTORIA
State : OR
Zip : 97103-2442
Country : US
Telephone Number : 503-338-7202
Fax Number :
Provider Business Practice Location Address
First Line : #10 PIER ONE
Second Line : SUITE 204
City : ASTORIA
State : OR
Zip : 97103-6338
Country : US
Telephone Number : 503-741-7418
Fax Number : 503-325-2903
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2014
Last Update Date : 02/02/2015

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