Healthcare Provider Details

I. General information

NPI: 1447619085
Provider Name (Legal Business Name): DIANA EVE EDWARDS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2016
Last Update Date: 02/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1614 E RANCHO DR
PHOENIX AZ
85016-2523
US

IV. Provider business mailing address

1614 E RANCHO DR
PHOENIX AZ
85016-2523
US

V. Phone/Fax

Practice location:
  • Phone: 602-248-9030
  • Fax: 602-248-3191
Mailing address:
  • Phone: 602-248-9030
  • Fax: 602-248-3191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1059
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: