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General NPI Number Information
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NPI Number | 1801173190
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Entity Type | Individual
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Provider Name | EDWARD RUSSELL LOBDELL LCPC, LCAC, PCCM
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Gender | Male
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Dates
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Enumeration Date | 11/15/2011
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Last Update Date | 09/18/2024
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Provider Practice Location Address
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Address Line | 1301 N 47TH ST BLDG A
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City | KANSAS CITY
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State | KS
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Zip | 66102-1705
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Country | US
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Telephone | 913-328-4600
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Fax |
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Provider Business Mailing Address
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Address Line | 1739 E 23RD ST
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City | LAWRENCE
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State | KS
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Zip | 66046-5017
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Country | US
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Telephone | 785-830-8238
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Fax | 785-830-8238
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 554
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2354
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License Number State | KS
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