Provider Demographics
NPI: | 1013559988 |
---|---|
Name: | EDWARDS, ALICE (LPPT, LCDC, MRT,MS) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | ALICE |
Middle Name: | |
Last Name: | EDWARDS |
Suffix: | |
Gender: | F |
Credentials: | LPPT, LCDC, MRT,MS |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 2100 WEST LOOP S STE 900 |
Mailing Address - Street 2: | |
Mailing Address - City: | HOUSTON |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 77027-3522 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 979-248-5649 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2100 WEST LOOP S STE 800 |
Practice Address - Street 2: | |
Practice Address - City: | HOUSTON |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77027-3522 |
Practice Address - Country: | US |
Practice Address - Phone: | 979-248-5649 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2019-10-12 |
Last Update Date: | 2020-06-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
101YP2500X, 103TB0200X, 103TC1900X, 101Y00000X, 101YM0800X, 103TF0000X, 106H00000X, 133N00000X, 171000000X, 171M00000X, 172V00000X, 174H00000X, 374K00000X | ||
MS | AE719444D | 101YP1600X |
TX | 10292 | 101YA0400X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional |
No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral |
No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling |
No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No | 101YP1600X | Behavioral Health & Social Service Providers | Counselor | Pastoral |
No | 103TF0000X | Behavioral Health & Social Service Providers | Psychologist | Family |
No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | |
No | 133N00000X | Dietary & Nutritional Service Providers | Nutritionist | |
No | 171000000X | Other Service Providers | Military Health Care Provider | |
No | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | |
No | 172V00000X | Other Service Providers | Community Health Worker | |
No | 174H00000X | Other Service Providers | Health Educator | |
No | 374K00000X | Nursing Service Related Providers | Religious Nonmedical Practitioner |