MEDICARE: EDT, INC.

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		IN

General Provider Information

NPI Number	:	1326111444
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDT, INC.

Provider Business Mailing Address
First Line	:	509 W WASHINGTON BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46802-2917
Country	:	US
Telephone Number	:	260-422-3034
Fax Number	:	260-422-3691

Provider Business Practice Location Address
First Line	:	509 W WASHINGTON BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46802-2917
Country	:	US
Telephone Number	:	260-422-3034
Fax Number	:	260-422-3691

Authorized Official
Title or Position	:	OWNER
Name	:	MS. EMMA D THOMAS
Credential	:	MS LCSW
Telephone Number	:	260-422-3034

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	08/22/2020

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Directions to “EDT, INC. ” Practice Location

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