MEDICARE: MARSHA L EDWARDS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	11573	TX
2	101YP2500X	Professional Counselor	68758	TX

General Provider Information

NPI Number	:	1427480227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARSHA L EDWARDS

Provider Business Mailing Address
First Line	:	6040 CAMP BOWIE BLVD STE 16
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-5602
Country	:	US
Telephone Number	:	214-604-7895
Fax Number	:	972-623-2871

Provider Business Practice Location Address
First Line	:	6040 CAMP BOWIE BLVD STE 16
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-5602
Country	:	US
Telephone Number	:	214-604-7895
Fax Number	:	972-623-2871

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

Provider Enumeration Date	:	08/02/2013
Last Update Date	:	08/02/2013

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Directions to “ MARSHA L EDWARDS ” Practice Location

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