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General NPI Number Information
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NPI Number | 1336386655
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Entity Type | Individual
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Provider Name | TERRY BERNARD EDWARDS LMSW
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Gender | Male
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Dates
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Enumeration Date | 01/08/2009
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Last Update Date | 09/30/2020
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Provider Practice Location Address
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Address Line | 5834 ADENMOOR AVE
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City | LAKEWOOD
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State | CA
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Zip | 90713-1002
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Country | US
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Telephone | 303-989-8169
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Fax |
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Provider Business Mailing Address
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Address Line | 255 W 5TH ST APT 122
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City | SAN PEDRO
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State | CA
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Zip | 90731-3389
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Country | US
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Telephone | 901-605-5128
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Fax | 213-267-9077
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 2016031084
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 3841-M
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License Number State | AR
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