Provider Demographics
NPI:1346322633
Name:EDMONDS, RITA (LCSW)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:
Last Name:EDMONDS
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 1:3707 N CANYON RD
Mailing Address - Street 2:# 2C
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-4596
Mailing Address - Country:US
Mailing Address - Phone:801-225-3111
Mailing Address - Fax:801-222-9404
Practice Address - Street 1:3707 N CANYON RD # 2C
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-4596
Practice Address - Country:US
Practice Address - Phone:801-225-3111
Practice Address - Fax:801-225-9809
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT136833-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical