MEDICARE: JOLAINE 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	101YM0800X	Mental Health Counselor	1541	NE

General Provider Information

NPI Number	:	1275639049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOLAINE EDWARDS LCSW

Provider Business Mailing Address
First Line	:	3314 26TH ST
Second Line	:	SUITE D
City	:	COLUMBUS
State	:	NE
Zip	:	68601-2304
Country	:	US
Telephone Number	:	402-562-7099
Fax Number	:	402-562-7099

Provider Business Practice Location Address
First Line	:	3314 26TH ST
Second Line	:	SUITE D
City	:	COLUMBUS
State	:	NE
Zip	:	68601-2304
Country	:	US
Telephone Number	:	402-562-7099
Fax Number	:	402-562-7099

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

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	07/08/2007

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