Provider Demographics
NPI:1629167564
Name:EDWARDS, LYNN (LPCC-S)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:
Other - Last Name:EDWARDS MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:408 9TH ST SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44707-4714
Mailing Address - Country:US
Mailing Address - Phone:330-454-2000
Mailing Address - Fax:234-215-3161
Practice Address - Street 1:408 9TH ST SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44707-4714
Practice Address - Country:US
Practice Address - Phone:330-454-2000
Practice Address - Fax:234-215-3161
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3536-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0215653Medicaid