Provider Demographics
NPI:1477044220
Name:EDWARDS, CARL NORMAND (JD PHD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:NORMAND
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:JD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4113 SUNFLOWER LN
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-4803
Mailing Address - Country:US
Mailing Address - Phone:774-200-0201
Mailing Address - Fax:
Practice Address - Street 1:4113 SUNFLOWER LN
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-4803
Practice Address - Country:US
Practice Address - Phone:774-200-0201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-27
Last Update Date:2018-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA798103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Single Specialty