Provider Demographics
NPI:1437134814
Name:EDWARDS, MICHAEL BEN (MFT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:BEN
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4408
Mailing Address - Country:US
Mailing Address - Phone:760-436-1151
Mailing Address - Fax:760-436-9862
Practice Address - Street 1:826 2ND ST
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4408
Practice Address - Country:US
Practice Address - Phone:760-436-1151
Practice Address - Fax:760-436-9862
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35616106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist