Healthcare Provider Details

I. General information

NPI: 1780057810
Provider Name (Legal Business Name): TIMIKA S EDWARDS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2015
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7110 OAKLAND AVE STE 105
SAINT LOUIS MO
63117-1870
US

IV. Provider business mailing address

PO BOX 430175
SAINT LOUIS MO
63143-0275
US

V. Phone/Fax

Practice location:
  • Phone: 314-270-2343
  • Fax: 314-925-9727
Mailing address:
  • Phone: 314-270-2343
  • Fax: 314-925-9727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2014040973
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2014040973
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: