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General NPI Number Information
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NPI Number | 1659709608
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Entity Type | Organization
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Legal Business Name | EDMONDSON FAMILY THERAPY
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Dates
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Enumeration Date | 10/29/2013
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Last Update Date | 10/29/2013
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Provider Practice Location Address
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Address Line | 1015 WATERWOOD PKWY SUITE G, L-2
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City | EDMOND
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State | OK
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Zip | 73034-5327
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Country | US
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Telephone | 405-315-7093
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Fax |
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Provider Business Mailing Address
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Address Line | 1015 WATERWOOD PKWY SUITE G, L-2
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City | EDMOND
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State | OK
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Zip | 73034-5327
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Country | US
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Telephone | 405-315-7093
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | JENNIFER ERIN EDMONDSON
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Credential | MA, LPC, LADC, CMIII
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Telephone | 405-315-7093
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 1067
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 5028
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License Number State | OK
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