Provider Demographics
NPI:1346318938
Name:EDWARDS, AUDREY MERRICK (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:MERRICK
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 S EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104
Mailing Address - Country:US
Mailing Address - Phone:702-474-6700
Mailing Address - Fax:702-474-0309
Practice Address - Street 1:1250 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104
Practice Address - Country:US
Practice Address - Phone:702-474-6700
Practice Address - Fax:702-474-0309
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01540-C103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV34166Medicare ID - Type Unspecified