Healthcare Provider Details

I. General information

NPI: 1942396080
Provider Name (Legal Business Name): DAVID JOSEPH EDWARDS MA, PROFESSIONAL COU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3132 OLD JACKSONVILLE RD
SPRINGFIELD IL
62704-7400
US

IV. Provider business mailing address

601 MAGNOLIA DR
CHATHAM IL
62629-1127
US

V. Phone/Fax

Practice location:
  • Phone: 217-862-0800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180006737
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: