Provider Demographics
NPI:1033297007
Name:EDMUNDS, DEBORAH DIANN (MA, LPC-S)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:DIANN
Last Name:EDMUNDS
Suffix:
Gender:F
Credentials:MA, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
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Mailing Address - Street 1:17510 HUFFMEISTER RD STE 103
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-6785
Mailing Address - Country:US
Mailing Address - Phone:281-373-5200
Mailing Address - Fax:281-373-5200
Practice Address - Street 1:17510 HUFFMEISTER RD
Practice Address - Street 2:103
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-6785
Practice Address - Country:US
Practice Address - Phone:281-373-5200
Practice Address - Fax:281-373-5202
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16682101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0287013-02Medicaid