Healthcare Provider Details

I. General information

NPI: 1346298866
Provider Name (Legal Business Name): CHRISTOPHER ARLEN EDWARDS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 E BROAD ST SUITE D
COOKEVILLE TN
38501-3389
US

IV. Provider business mailing address

441 E BROAD ST SUITE D
COOKEVILLE TN
38501-3389
US

V. Phone/Fax

Practice location:
  • Phone: 931-520-0535
  • Fax: 931-520-0537
Mailing address:
  • Phone: 931-520-0535
  • Fax: 931-520-0537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberP2278
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-202526
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberP2278
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberP2278
License Number StateTN
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP2278
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: