Healthcare Provider Details

I. General information

NPI: 1447621677
Provider Name (Legal Business Name): GLENDA EDWARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2015
Last Update Date: 10/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 RURAL ST
LAFAYETTE LA
70508-3934
US

IV. Provider business mailing address

120 RURAL ST
LAFAYETTE LA
70508-3934
US

V. Phone/Fax

Practice location:
  • Phone: 337-233-7250
  • Fax: 337-233-7104
Mailing address:
  • Phone: 337-233-7250
  • Fax: 337-233-7104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: