MEDICARE: MRS. BRANDI LASHAYE EDWARDS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	3838-C	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5WW24	OTHER	AR	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114179934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRANDI LASHAYE EDWARDS LCSW

Provider Business Mailing Address
First Line	:	1815 PLEASANT GROVE RD
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72401-7870
Country	:	US
Telephone Number	:	870-933-6886
Fax Number	:	870-933-9395

Provider Business Practice Location Address
First Line	:	1200 JAMES STREET
Second Line	:
City	:	JACKSONVILLE
State	:	AR
Zip	:	72076-3143
Country	:	US
Telephone Number	:	501-982-5000
Fax Number	:	501-982-5007

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2008
Last Update Date	:	02/16/2016

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