Provider Demographics
NPI:1386024784
Name:EDWARDS, SHELBY LYNN (MSW)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:LYNN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 W OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:RICHVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:62877-1974
Mailing Address - Country:US
Mailing Address - Phone:618-533-1391
Mailing Address - Fax:618-533-0012
Practice Address - Street 1:432 W OLIVE ST
Practice Address - Street 2:
Practice Address - City:RICHVIEW
Practice Address - State:IL
Practice Address - Zip Code:62877
Practice Address - Country:US
Practice Address - Phone:618-533-1391
Practice Address - Fax:618-533-0012
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health