Healthcare Provider Details

I. General information

NPI: 1427359314
Provider Name (Legal Business Name): LAURIE EDWARDS PHD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 01/17/2024
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 ALTA VISTA ST STE 5
SANTA FE NM
87505-4140
US

IV. Provider business mailing address

903 W ALAMEDA ST
SANTA FE NM
87501-1681
US

V. Phone/Fax

Practice location:
  • Phone: 808-772-0423
  • Fax: 866-821-5133
Mailing address:
  • Phone: 808-772-0423
  • Fax: 866-821-5133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 1108
License Number StateHI

VIII. Authorized Official

Name: DR. LAURIE EDWARDS
Title or Position: OWNER
Credential: PHD
Phone: 808-772-0423