Provider Demographics
NPI:1316603822
Name:EDWARDS, TARYN LANNETTE
Entity Type:Individual
Prefix:
First Name:TARYN
Middle Name:LANNETTE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5554 RESEDA BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-6212
Mailing Address - Country:US
Mailing Address - Phone:818-795-5522
Mailing Address - Fax:
Practice Address - Street 1:5554 RESEDA BLVD STE 203
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-6212
Practice Address - Country:US
Practice Address - Phone:818-705-5522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician