Healthcare Provider Details

I. General information

NPI: 1982285748
Provider Name (Legal Business Name): DAVID EDWARDS LPC, LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 W NEZ PERCE
JEROME ID
83338-5077
US

IV. Provider business mailing address

218 W NEZ PERCE
JEROME ID
83338-5077
US

V. Phone/Fax

Practice location:
  • Phone: 208-324-3471
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC-20894
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCPC-8321282
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-23359
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC-CCMH0223451
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: