Healthcare Provider Details

I. General information

NPI: 1700101649
Provider Name (Legal Business Name): EDWARD A SADDY M.A., LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2010
Last Update Date: 02/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 METHODIST ENCAMPMENT RD STE 17
KERRVILLE TX
78028-2834
US

IV. Provider business mailing address

717 HILL COUNTRY DR APT 2103
KERRVILLE TX
78028-5962
US

V. Phone/Fax

Practice location:
  • Phone: 737-206-1277
  • Fax:
Mailing address:
  • Phone: 737-206-1277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number64054
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number64054
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number64054
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number64054
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: