Provider Demographics
NPI:1336511666
Name:EDWARDS, JENNIFER (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 S CENTRAL EXPY
Mailing Address - Street 2:SUITE 235
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-4070
Mailing Address - Country:US
Mailing Address - Phone:214-288-6580
Mailing Address - Fax:
Practice Address - Street 1:2150 S CENTRAL EXPY
Practice Address - Street 2:SUITE 235
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-4070
Practice Address - Country:US
Practice Address - Phone:214-288-6580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX302891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical