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General NPI Number Information
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NPI Number | 1033764345
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Entity Type | Individual
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Provider Name | EDGAR LEE ETIENNE
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Gender | Male
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Dates
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Enumeration Date | 08/04/2019
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 1176 CYPRESS GLEN CIR
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City | KISSIMMEE
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State | FL
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Zip | 34741-7560
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Country | US
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Telephone | 407-201-2103
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Fax |
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Provider Business Mailing Address
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Address Line | 2531 NE 3RD TER
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City | POMPANO BEACH
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State | FL
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Zip | 33064-4538
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Country | US
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Telephone | 754-242-1613
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | FL
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