Provider Demographics
NPI:1568162329
Name:EDELWEISS THERAPY, PLLC
Entity Type:Organization
Organization Name:EDELWEISS THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED CLINICAL SOCIAL WORK
Authorized Official - Prefix:
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BONNEAU
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:979-353-2488
Mailing Address - Street 1:4030 STATE HIGHWAY 6 S STE 210
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-1805
Mailing Address - Country:US
Mailing Address - Phone:979-353-2488
Mailing Address - Fax:
Practice Address - Street 1:4030 STATE HIGHWAY 6 S STE 210
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-1805
Practice Address - Country:US
Practice Address - Phone:979-353-2488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)