Provider Demographics
NPI:1689948788
Name:EDMUNDSON, ERIC LEONARD (MAMFT, CIT)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:LEONARD
Last Name:EDMUNDSON
Suffix:
Gender:M
Credentials:MAMFT, CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901B AIRLINE DR
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-5936
Mailing Address - Country:US
Mailing Address - Phone:504-833-4673
Mailing Address - Fax:504-885-0400
Practice Address - Street 1:1901B AIRLINE DR
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-5936
Practice Address - Country:US
Practice Address - Phone:504-833-4673
Practice Address - Fax:504-885-0400
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAC.I.T., #2759101YA0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health