Healthcare Provider Details

I. General information

NPI: 1154372134
Provider Name (Legal Business Name): CHERYL LEE EDWARDS M.S., L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4951 OLD GREENWOOD RD
FORT SMITH AR
72903-6906
US

IV. Provider business mailing address

4951 OLD GREENWOOD RD
FORT SMITH AR
72903-6906
US

V. Phone/Fax

Practice location:
  • Phone: 479-709-9880
  • Fax: 479-709-9887
Mailing address:
  • Phone: 479-709-9880
  • Fax: 479-709-9887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP0311044
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP0311044
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: