Provider Demographics
NPI:1003043142
Name:EDMONDS, WILLIAM ALEXANDER (PHD, BCIAC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ALEXANDER
Last Name:EDMONDS
Suffix:
Gender:M
Credentials:PHD, BCIAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 600568
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-0568
Mailing Address - Country:US
Mailing Address - Phone:305-322-0423
Mailing Address - Fax:
Practice Address - Street 1:1750 NE 167TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3017
Practice Address - Country:US
Practice Address - Phone:305-322-0423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLB 5020101Y00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101Y00000XBehavioral Health & Social Service ProvidersCounselor