Provider Demographics
NPI:1083621874
Name:EDWARDS, LEE THOMAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:THOMAS
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5213 LERALYNN ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-1915
Mailing Address - Country:US
Mailing Address - Phone:512-467-0923
Mailing Address - Fax:
Practice Address - Street 1:4103 MARATHON BLVD
Practice Address - Street 2:100B
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3719
Practice Address - Country:US
Practice Address - Phone:512-458-9787
Practice Address - Fax:512-458-8752
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31266103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00862EMedicare ID - Type Unspecified