Healthcare Provider Details

I. General information

NPI: 1669307138
Provider Name (Legal Business Name): STACY LYNETTE EDWARDS MFT-I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23710 US HIGHWAY 98 STE A1
FAIRHOPE AL
36532-6350
US

IV. Provider business mailing address

23710 US HIGHWAY 98 STE A1
FAIRHOPE AL
36532-6350
US

V. Phone/Fax

Practice location:
  • Phone: 251-210-9959
  • Fax:
Mailing address:
  • Phone: 251-210-9959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberI-168
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: