Provider Demographics
NPI:1528575982
Name:EDWARDS, JODIE KAE (PHD, LPCC-S)
Entity Type:Individual
Prefix:DR
First Name:JODIE
Middle Name:KAE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PHD, LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7570 BALES ST STE 380
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45069-7516
Mailing Address - Country:US
Mailing Address - Phone:513-914-4688
Mailing Address - Fax:
Practice Address - Street 1:7570 BALES ST STE 380
Practice Address - Street 2:
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45069-7516
Practice Address - Country:US
Practice Address - Phone:513-914-4688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0700405101YM0800X
OH6752103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical