Provider Information for 1396495768
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JONATHAN F EDWARDS LPC
Sex: Male
NPI: 1396495768
Last Updated: 2022-03-28
Certification Date: 2022-03-28
Certification Date: 2022-03-28
Details
Name | Value | ||||||||||||||
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NPI | 1396495768 | ||||||||||||||
Enumeration Date | 2022-03-28 | ||||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||||
Sole Proprietor | NO | ||||||||||||||
Status | Active | ||||||||||||||
Mailing Address | 1002 FRANKFORD AVE APT 1114C LUBBOCK, TX 79416-5071 United States Phone: 858-537-7269 | Fax: | ||||||||||||||
Primary Practice Address | 1002 FRANKFORD AVE APT 1114C LUBBOCK, TX 79416-5071 United States Phone: 858-537-7269 | Fax: | ||||||||||||||
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