Healthcare Provider Details

I. General information

NPI: 1144912106
Provider Name (Legal Business Name): EDGE COUNSELING & CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 SUNFLOWER DR
FAIRFAX IA
52228-7608
US

IV. Provider business mailing address

309 SUNFLOWER DR
FAIRFAX IA
52228-7608
US

V. Phone/Fax

Practice location:
  • Phone: 319-350-0921
  • Fax:
Mailing address:
  • Phone: 319-350-0921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225CA2500X
TaxonomyAssistive Technology Supplier Rehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KYLE R SPADING
Title or Position: PRESIDENT/OWNER
Credential: LMHC, CRC
Phone: 319-350-0921