Provider Demographics
NPI:1275949091
Name:EDWARDS, AMY DEFOREST (ACMHC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:DEFOREST
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 E 1700 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-3328
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:JEWISH FAMILY SERVICE
Practice Address - Street 2:1111 E BRICKYARD RD, SUITE 218
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84106
Practice Address - Country:US
Practice Address - Phone:801-746-4334
Practice Address - Fax:801-746-4337
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-02
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9045126-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health