Provider Demographics
NPI:1225154693
Name:MIDDLETON, EDWARD JR (MA, MDIV, LPC)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:
Last Name:MIDDLETON
Suffix:JR
Gender:M
Credentials:MA, MDIV, LPC
Other - Prefix:MR
Other - First Name:EDWARD
Other - Middle Name:B
Other - Last Name:MIDDLETON
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MA, MDIV, LPC
Mailing Address - Street 1:22160 TALBOT DR
Mailing Address - Street 2:
Mailing Address - City:PLAQUEMINE
Mailing Address - State:LA
Mailing Address - Zip Code:70764-5214
Mailing Address - Country:US
Mailing Address - Phone:225-573-6982
Mailing Address - Fax:
Practice Address - Street 1:763 NORTH BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70802-5725
Practice Address - Country:US
Practice Address - Phone:225-387-2287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA33888101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional