Provider Demographics
NPI:1114446713
Name:EDWARDS, JESSICA LEE (TLMHC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:TLMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 FLINDT DR STE 104
Mailing Address - Street 2:
Mailing Address - City:STORM LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50588-3208
Mailing Address - Country:US
Mailing Address - Phone:800-242-5101
Mailing Address - Fax:
Practice Address - Street 1:824 FLINDT DR STE 104
Practice Address - Street 2:
Practice Address - City:STORM LAKE
Practice Address - State:IA
Practice Address - Zip Code:50588-3208
Practice Address - Country:US
Practice Address - Phone:800-242-5101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-14
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
IA094752101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA101YM0800XMedicaid