Provider Demographics
NPI:1194251579
Name:EDWARDS, DANIEL
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 S ACADIAN THRUWAY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-6900
Mailing Address - Country:US
Mailing Address - Phone:225-223-6968
Mailing Address - Fax:225-442-1396
Practice Address - Street 1:1200 S ACADIAN THRUWAY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6900
Practice Address - Country:US
Practice Address - Phone:225-223-6968
Practice Address - Fax:225-442-1396
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health