Provider Demographics
NPI:1154472470
Name:RISLER, EDWIN AURELIO (PHD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:AURELIO
Last Name:RISLER
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 1:598 S MILLEDGE AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-1262
Mailing Address - Country:US
Mailing Address - Phone:706-353-0709
Mailing Address - Fax:706-549-3167
Practice Address - Street 1:598 S MILLEDGE AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-1262
Practice Address - Country:US
Practice Address - Phone:706-353-0709
Practice Address - Fax:706-549-3167
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0010541041C0700X
GAMFT000260106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACSW001054OtherLCSW
GAMFT000260OtherMFT