Provider Demographics
NPI:1346298866
Name:EDWARDS, CHRISTOPHER ARLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ARLEN
Last Name:EDWARDS
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 1:441 E BROAD ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-3389
Mailing Address - Country:US
Mailing Address - Phone:931-520-0535
Mailing Address - Fax:931-520-0537
Practice Address - Street 1:441 E BROAD ST
Practice Address - Street 2:SUITE D
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-3389
Practice Address - Country:US
Practice Address - Phone:931-520-0535
Practice Address - Fax:931-520-0537
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP2278103T00000X, 103TC2200X, 103TH0100X, 103TC0700X
IDPSY-202526103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3133273OtherBC/BS OF TENNESSEE
TN3981616Medicaid
TX3981616Medicare ID - Type Unspecified