Healthcare Provider Details

I. General information

NPI: 1326809997
Provider Name (Legal Business Name): MARCIA LYNN EDWARDS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2024
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 FRED TAYLOR DR FL 2
COLUMBUS OH
43202-1552
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-3600
  • Fax: 614-293-2910
Mailing address:
  • Phone: 614-293-3600
  • Fax: 614-293-2910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License NumberP.08593
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP.08593
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: