Provider Demographics
NPI:1427308709
Name:EDWARDS, BLYTHE ELLEN (MS, LCPC-C)
Entity type:Individual
Prefix:MS
First Name:BLYTHE
Middle Name:ELLEN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MS, LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 RIVERSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-1070
Mailing Address - Country:US
Mailing Address - Phone:207-871-1211
Mailing Address - Fax:207-871-1232
Practice Address - Street 1:220 DANVILLE CORNER RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-8605
Practice Address - Country:US
Practice Address - Phone:207-956-3346
Practice Address - Fax:207-871-1232
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL3966101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor