Healthcare Provider Details

I. General information

NPI: 1619897469
Provider Name (Legal Business Name): MICHELLE EDWARDS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 S MARKET ST
OTTUMWA IA
52501-2923
US

IV. Provider business mailing address

PO BOX 458
OTTUMWA IA
52501-0458
US

V. Phone/Fax

Practice location:
  • Phone: 641-683-5773
  • Fax: 641-226-5759
Mailing address:
  • Phone: 641-683-5773
  • Fax: 641-226-5759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number114190
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: