Provider Demographics
NPI:1841450418
Name:EDWARDS, LEE (MED, NCC, LPC-S)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MED, NCC, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 TOWNE NORTH DR
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-7921
Mailing Address - Country:US
Mailing Address - Phone:972-998-1865
Mailing Address - Fax:
Practice Address - Street 1:214 N CADDO ST
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76031-4904
Practice Address - Country:US
Practice Address - Phone:972-998-1865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64201101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8381LCOtherBLUE CROSS BLUE SHIELD
TX307356101Medicaid
TX307356102OtherMEDICAID CSHCN
TX64201OtherLPC