Healthcare Provider Details

I. General information

NPI: 1629414305
Provider Name (Legal Business Name): COURTNEY LYNN EDGAR LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S. RAISINVILLE ROAD P.O. BOX 726
MONROE MI
48161-0726
US

IV. Provider business mailing address

1001 S RAISINVILLE RD
MONROE MI
48161-9754
US

V. Phone/Fax

Practice location:
  • Phone: 734-243-7340
  • Fax:
Mailing address:
  • Phone: 734-243-7340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401013641
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: