Provider Demographics
NPI:1982285748
Name:EDWARDS, DAVID (LPC, LPCC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:
Credentials:LPC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:572 MESA GRANDE LOOP
Mailing Address - Street 2:
Mailing Address - City:JEROME
Mailing Address - State:ID
Mailing Address - Zip Code:83338-3001
Mailing Address - Country:US
Mailing Address - Phone:909-229-4822
Mailing Address - Fax:
Practice Address - Street 1:218 W NEZ PERCE
Practice Address - Street 2:
Practice Address - City:JEROME
Practice Address - State:ID
Practice Address - Zip Code:83338-5077
Practice Address - Country:US
Practice Address - Phone:208-324-3471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLPCC-CCMH0223451101YM0800X
AZLPC-23359101YM0800X
IDLPC-4749101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health