Healthcare Provider Details

I. General information

NPI: 1669554937
Provider Name (Legal Business Name): ROBERT EDMONDS LPE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4325 HIGHWAY 127 N
CROSSVILLE TN
38571-0587
US

IV. Provider business mailing address

118 N CHURCH ST
MURFREESBORO TN
37130-3636
US

V. Phone/Fax

Practice location:
  • Phone: 931-484-8020
  • Fax: 931-456-6916
Mailing address:
  • Phone: 615-278-2241
  • Fax: 615-904-9182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1791
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: