Provider Demographics
NPI:1689708059
Name:EDWARDS, BARBARA ANN (PSYD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 FILER ST
Mailing Address - Street 2:STE 320
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-2726
Mailing Address - Country:US
Mailing Address - Phone:231-723-1140
Mailing Address - Fax:231-723-7140
Practice Address - Street 1:50 FILER ST
Practice Address - Street 2:STE 320
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-2726
Practice Address - Country:US
Practice Address - Phone:231-723-1140
Practice Address - Fax:231-723-7140
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009229103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist