Provider Demographics
NPI:1437581055
Name:POE, EDWARD LEE (LPC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:LEE
Last Name:POE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2737 S BROADWAY AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-5413
Mailing Address - Country:US
Mailing Address - Phone:903-533-1817
Mailing Address - Fax:903-593-3385
Practice Address - Street 1:2737 S BROADWAY AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-5413
Practice Address - Country:US
Practice Address - Phone:903-533-1817
Practice Address - Fax:903-593-3385
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62137101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional