Provider Information for 1114357043
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MIEASHA EDMONDS MA, MDiv,LPC
Sex: Female
NPI: 1114357043
Last Updated: 2019-07-29
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1114357043 | ||||||||
| Enumeration Date | 2013-11-13 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | PO BOX 66308 HOUSTON, TX 77266-6308 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 9606 MESA DR HOUSTON, TX 77078-3024 United States Phone: 832-548-5000 | Fax: | ||||||||
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