Provider Demographics
NPI:1043826175
Name:EDWARDS, EMILY BRIANNE
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:BRIANNE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 E SOUTHWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-3698
Mailing Address - Country:US
Mailing Address - Phone:765-201-0025
Mailing Address - Fax:765-319-0585
Practice Address - Street 1:217 E SOUTHWAY BLVD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3698
Practice Address - Country:US
Practice Address - Phone:765-201-0026
Practice Address - Fax:765-319-0585
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health