Healthcare Provider Details

I. General information

NPI: 1427308709
Provider Name (Legal Business Name): BLYTHE ELLEN EDWARDS MS, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 HILLCREST AVE
RANDOLPH ME
04346-5131
US

IV. Provider business mailing address

9 HILLCREST AVE
RANDOLPH ME
04346-5131
US

V. Phone/Fax

Practice location:
  • Phone: 207-956-3346
  • Fax: 207-871-1232
Mailing address:
  • Phone: 207-871-1211
  • Fax: 207-871-1232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC3471
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: