Healthcare Provider Details

I. General information

NPI: 1932657541
Provider Name (Legal Business Name): ALEX EDWARDS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 02/19/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 INDEPENDENCE DR.
TRUMANN AR
72472
US

IV. Provider business mailing address

1707 LINWOOD DR STE B
PARAGOULD AR
72450-5365
US

V. Phone/Fax

Practice location:
  • Phone: 870-970-4383
  • Fax: 888-977-2953
Mailing address:
  • Phone: 870-604-4455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10115-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: