Provider Demographics
NPI:1124183942
Name:EDENS, ANETTE TEMPLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANETTE
Middle Name:TEMPLE
Last Name:EDENS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 LOUISE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77009-2956
Mailing Address - Country:US
Mailing Address - Phone:713-252-2290
Mailing Address - Fax:
Practice Address - Street 1:1040 LOUISE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77009-2956
Practice Address - Country:US
Practice Address - Phone:713-252-2290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25242103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U6XMedicare PIN