Provider Demographics
NPI:1407656770
Name:EDWARDS, GABRIELLE ELVESSIE
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ELVESSIE
Last Name:EDWARDS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1244 REGENTS PARK CT
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2837
Mailing Address - Country:US
Mailing Address - Phone:972-400-3572
Mailing Address - Fax:
Practice Address - Street 1:1244 REGENTS PARK CT
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2837
Practice Address - Country:US
Practice Address - Phone:972-400-3572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician